1301 NE 101 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date /9 )Job Address /3 / Pt, / o S I ✓2-e/ Tax Folio
Legal Description 9
Owner / Lessee / Tenant 6° -0I1 C C41-6 a (4
Owner's Address Phone
4490 / /c/s
Contracting Co. bSS /C POO /s -'C,
Qualifier )T ,1/r L EST/4 SS# Phone /41 &Q9'Q
State # Ofec9 S 2565 Municipal # J Competency # Ins.Co.67 /�e /3a'®w
Architect /Engineer N / Address
Bonding Company /V, Address /
1
Mortis r' /� /f4 Address A-
Permit Type(circle one ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ` )//ilL /5(t j it"i/V& 7 ,, A 0711 / 11. " 74,
Square Ft. Estimated Cost(value) 9
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
be done in compliance with all applicable laws regulating s ru
authorize the above -named contractor to do the work sta
Signat e owner nd /or Condo President
Date:
,Jo t C. CA-KC/4
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * *
Address
Master Permit # 7 _33
urate and that all work will
nd zoning. Furthermore, I
Sig
Da e:
r- >f- pThi
Notary as to Contr
My Commission Exp
of Contrac or or Owner- Builder
STATE OF FIN V
M Comm Exp$ /29/95
BONDED
**
FEES: PERMIT 37 S � RADON C.C.F. / NOTARY TOTAL,DUE 3 0.-
APPROVED: Fire Other
Zoning Buildin Electrical
Mechanical Plumbing Engineering
00