1290 NE 100 StPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date L( /15 /a 3 Job Address
•
Legal Description (% '
/ Tenant s i-21,4%7
Address / LP V) t
Contracting Co. �'(� r4 J'_/ A lit(C Address /f (/E )/2
Qualifiers/ LL' *7-444x :U. / ' - Phone RY ` / 9
State C f Dt /?.Municipal # Competency # Ins .Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRRICAL , P J L � UMBINGMECHAN NI ICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION //VS[ ,41L (s-/�`�J/
Owner / Lessee
Owner s
Square Ft. Estimated Cost(value)1j 2C?4 •
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 cons.ructio and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
,1 � ,, /
1. tar r
y Commission Expires
** *
APPROVED:
ce
Si ature oV a-t a_ r_ '''
D e :A///6/
as to Owner an
• ' ' ''''''I;. JOSEPHINE CHURCH
` r _'TI
4 M _.
•
1 S*Yve± Tax
6-4 /
d.Vny E3aslssi,d, 30.1
A:' Na CC197545
Folio , x(0 5' 0 7 0'07P 6
Signs ure of Contractor or Own ilder
Date: it/Ai 19.3
lei % �.11 au�z,/
Lary /as to Contractor or Owner- Builder
My Commission Expires:
Master Permit #
Phone
* **
FEES: PERMIT ; RADON C.C.F. � 'C' ° NOTARY S<DO TOTAL DUE 7.
Fire Other
Zoning Building 0V 95 Electrical
Mechanical Plumbing Engineering
rt
arty describe. as;
t BORES,
`�sCt�>t'd'ah to the Plat
'>�� H �s 'recorded in
l "tt' . Bdbk . 43, Page 80•
if'ihe;.)t Records of
b,de`toUn Florida.
{ t4o€et encroachments and
,• )iti,•]itic "s',' if any, not. located. Fence
• ownership;by visual means only, legal
. owner'shl p not determined.
Certifier +;,To: Consolidated Title Co.,
'hMenned•,' "'John and Marie and '.Dow Guarantee
; ;:.Copp: -•,� itn; successors and /Q assigns .
•
NO 'valet i4;!(44 1
tk VeV,yWir.SetfiI
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4 �►P� d-174'
A BOUNDARY SURVEY
I hereby certify that the survey repre-
sented hereon meet$ .the minimum
technical standards'aet forth by the
Board of Land Surveyor pursuant to
Sectio 472.027. Fla. Statutes. Theoa are
nos roachmenes,OV • easements
'ap ring on the . Or o er tan s
sho hereto.
fla. Reg. Land
FLOOD ZONE: Al
111
FLOOD INFORMATION:
Community No.: 125098
p Panel No.: 93
Suffix: F
Date of FIRM: 11 -4 -87
0 Base Elevation: 48.00 N.G.V.D.
49 N.G.V.D.
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$
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1290 N.E. 100th Street, Miami Shores
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LANNES and GARCIA, INC.
ENGINEERS - LAND SURVEYORS - LAND PLANNERS
Office address: 359 Alcazar Avenue, Coral Gables. Florida 13134
Mailing address: P.O. Bon 561131, Miami, Florida 33156