WINDOWS-2000Date
PERMIT APPLICATION FOR MIAMI SHORE VILLAGE
00 Job d �(/ / U /POI Tax Folio
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Historically Designated: Yes
Master Permit # 4/ /
Legal ' :. "ption v� c c r� l c P� S - R
Owner/Lessee / Tenant �- A C�aive �i� 2L
Owner's Address i��, 1 7E - /DD Phone
Contracting Co. 00/9 / 1/ ea Address
Qualifier e 4r / /
2 c? 0 SS# .�� Phone 5 , 2 : - /c20 45 -S
State # C 6e °tel/ Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANIC
WORK DESCRIPTION /m 7 �!/M/CU.S
ee
Square Ft. Estimated Cost (value)
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 FIN ANCING, 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 hddendum (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 eparate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing
construction and zoning. Wiletnlqw. I authorize the
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Signature o O . ' '
Notary as
My Comm
APPROVED:
Zoning
Mechanical
FEES: PERMIT .6 p RADON
Building
Plumbing
Competency #
Address
Address
information is accurate and that all work will be done iii compliance with all applicable laws regulating
above -named contractor to do the work stated
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e Notary : t ..P' :g : 6m '°!" " -Builder
My Commissi :,..
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Electrical
A, / %'e
Structural Engin
Ins. Co.
No
ROOFING PAVING FENCE SIGN
BOND
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TOTAL DUE (/
Date
NOTICE OF COMMENCEMENT
A RECORDEb COPY MUST BE POSTED ON THE JOB SITE AT TIME OF
PERMIT NO. TAX FOLIO NO. // 4 2DS — 411 ov7
FIRST INSPECTION
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and in accordance with
iM / ' .�� 7� Orf C
STATE OF FLORIDA:
COUNTY OF DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address: l 2. S 7 F , /On S / ',/.'r
2. Description of improvement: � 11 Z )'v ZLb '
3. Owner(s) name and address: � hE / : ! ' Q/ ` e >"
/cam C S Y /D i IZ
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Interest in property:
Name and address of fee simple titleholder:
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4. Contractor's name and address: / 155g ij/
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5. Surety:(Payment bond required by owner from contractor, if any)
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
may be served as provided
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's
Section 713.13(1)(b), Florida Statutes.
Name and address:
Notice as provided in
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of Lording unless a
different date is specified)
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Signature of • ner / � • . • '• \SSI� 1 , . ji
Print Owners Name • ��' �� Prepared
Sworn to and subscribe bifore - 's / day •f ,.. .70 D
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:• de , • 4l I Addre �
Notary Public ! • r P
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Print Notary's Name IIII \ \\
My Commission Expires:
12901.52 2/99
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STATE OF FLORIDA, COUNT OF DADE
I HEREBY CERTIFY that this is a true o, the
orlgu ed in this othce on day
of
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LYI1 f'4y0S my hand and 011/cial S eal.
i IALZ / 'EY � ININ � I ER{ I and County Courts
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