150 NE 100 St (13)Date
Legal Description 1-613 R d- L I
Owner •/ Lessee / Tenant Master Permit Iij0,S7
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address /..50 - 22 E2 . l/12
Tax Folio //• 3.706 -O/3- 2/'0
/[. �• U l, j .33 /•2? Phone 75g• -•
Owners Address / 5
Contracting Co. .Sec r1 + Link A/'7'IerI Tech Address i P.fe ,33/3g
Qualifier Ga SS# Phone 7$Q- 7s
State iWoodo61 Municipa
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE S
.-��
WORK DESCRIPTION 7..di
/— o) Z A ,e . / 9 -
Square Ft. Estimated Cost(value) /5
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
30 MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS•TO YOUR PROPERTY (IF YOU INT:
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y(
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above,
on the attached addendum (if applicable). I certify that all work will be performed to meet
standards of all laws regulating construction in this jurisdiction. I 'understand that sepal
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
be done in compliance with all applicable laws regulating cons -`
authorize the above -named contractor to do the work stated.
te
owner? and/
Signature $
Date'
6 g 1v
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NdE ary as
My Commi
to
Mn.•han; Pa 1
4 'R/07 A)A'/Y?C
Sh k -Fe l f
!(
Owner and /or Condo President
ire IZICIAL NOTARY SEAL
SARINA M HIRSCH
n COMMISSION NUMBER
Q pC71 * 1
4 MY COMPASSION EXPIRES
MAR.. 1 2002
Competency 4 ns.Co.
Condo Presi9nt
RADON
ion and zoning. Furthermore
Signature of Contractor or Owner- Builder
Date:
Notary ts P o " nt19B5 mlbNEhimE r- Builder
Tr �I5S$ON NUMBER
M Co s :. ,�, P 1
< CC679543
j p%
9j ! � MY COMMISSION EXPIRES
* * FqF F *
SEPT 11,2001
C.C.F. 470 NOTARY TOTAL DUE
Other
Fire
Building Electrica
4
Plumbing Engineering