133 NE 100 St (3)Date
Legal Description &T'5 1 `f �q , ati„Oc.� ),c o114. tff J- listori c all y Designated: Yes No x
Owner/Lessee / Tenant Mil/ / 4r4. s va b y J TA g7 Master Permit #
Owner's Address 13 3 / V ' / 6�0 `, 5'4 1,4,...24.4,; shout, 3 3 Pho f /57 - 8
7 c
Contracting Co.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address / 33 NE / 0 0 Tax Folio 11 3 2 0 ' G ( Zd.SO
N/A-
Address
Qualifier SS# - I . -
State # Municipal # Competency # _ f
Architect/Engineer Address (:k41
Autumn Croc Z I
Bonding Company Address ,1357
MortgagorM �z. .ct Mh1{tT(94G (z t CtrRi. Address 2/E — - — --411Ir
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION P4/"N T D u S / DE.- q .0'I S G
Square Ft Estimated Cost (value) `� � 01 .. 01 .. a 0
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 Sign of s actor or Owner- Builder , Dat
;&/}) ,_""
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date 17
My Commission Expires: My Commis on x Gl.A NOTARY L
'GARY PUBUC STATE OF FLORIDA
COMMISSION NO. CC714103
MY 0 t MISSION EXP. MAR.1
FEES: PERMIT RADON
C.C.F. NOTARY BOND
TOTAL DUE
APPROVED:
Zoning Building � � ` 1 Electrical
Mechanical Plumbing Engineering
33 0a
InlilliaMn 3 �ady
3wtia+.4c 14.ow+t
ts 4/,
---11 ( ) AAJt '(4444.134"f)