1266 NE 101 St (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Q v' (- Job Address /A4'&' A e /01 Tax Foli
Legal Description I`- [ / bei3C14--
Owner / Lessee / Tenant atA40 , a- , (C..4 1 C , i. P v
- 1
Owner's Address IDG k..)E__ I C c� ' A' i'hC /, ,,
Contracting Co. Address
Qualifier
ele
State # Municipal 1f Competency #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING SIGN
WORK DE SCR I PT ION IflarC-AN\ - �-Q C k�l Irk- k t �1 y 1LCC,
v
woocitf x 1Z6 c- t 6 w
Square Ft. Estimated Cost(value) 0)600.00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
author.ze the above -nam • contr =ctor to do the work stated.
it : � ••
. CHURCH
! ,r f17• Vasiod
° ; M CW97SIS
Signatu of owner and
Date: 7 /IJf)
G /
Nary f s to Owner anaferal106nettnE
My Commission Expires >'Pe ana nui J
APPROVED:
Zoning
stam
name of Notar Public
DIU take an oath, or
** * * * , D 1D No ' take a oath, *
FEES: PERMIT j 0' Q 40 RADON C.C.F. 1 S�
SS# - - Phone
Mechanical Plumbing
oil 3aO5 cb o('/QC)
Master Permit 4P 3-
Phone 16
Ins.Co.
Signature of Contractor or Z Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * * **
NOTARY TOTAL DUE. 4 ' 52
Other
Electrical
Engineering
. co GAL. •;:'
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date 1,,6- i Job Address !2(p(0 e.7 10(
Legal Description Master Permit # 3 /g
0
ViLY) d bOlD( in l 1( cO6Q
Owner's Address 1 Z (p1p t 10 7 IGVYW Shot! .
Contracting Co. Address
Qualifier SS# - - Phone
State# Competency# Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Owner / Lessee / Tenant
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WOR K DESCRIPTION VITIlsbIGUCtUr UO ODSt Qik_ iri,Ck�. �( `j (h O c 1/16A4-(...1
100 -
Square Ft. Estimated Cost SW pp
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
will be done in compliance with all applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
* . * �k *
PERMIT FEE:
"1 c91 ct) o
d� 07
APPROVED:
Zoning
Building
Mechanical Plumbing
Tax Folio
Signature f Contract
at '% / 9h
Phone 1 158- gSb(o
Owner - Builder
Notary as to Contracto q Q�
My irgcri ��6L1�'�fA�E�R�L
qp * yIC * * Commission Ex * * p 1N OMIMSSl( EXPIRES 5/09/94
Bo nded Yhro St mbler•Adar� Sweet Fire Other
Electrical
Engineering
- MIAMI SHORES VILLAGE, FLA. N9 8250
JOB
ADDRESS 1 , / - ��
INSPECTION 7> ` R (--
TIME READY
REMARKS:
INSPECTOR
DATE
1;/1AMI SHORES VILLAGE, FLA. N9 7910
JOB `", r �� ._ .
ADDRESS V? . ' t -,
INSPECTION -
- 7 — Z-� - sr
TIME READY
REMARKS:
INSPECTOR
DATE