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16 NE 100 St (8)Da Legal Description Owner/Lessee / Tenant om, Owner's Address 1 ICJ Contracting Co. Qmlifier \Aj State #: hO21' PERMIT A FOR MIAMI SHORES VILLAGE Job Address I 1 V U i ( C Tax Folio ( 3( i g i4 0 Municipal # Architect/Engineer Bonding Company Mortgagor Address WORK DESCRIPTION Signature of • er an • or o . . APPROVED: Zoning Mechanical ident FEES: PERMIT 3-4 ' RADON Date Chtea (J?, Notary as to Ownes� c cnds l?rm 'fit ` 1 Date My Co ission ExpifeL,.? \ tr�� 1 © Historically Designated: Yes No e ?, Master Permit # 14s -a ` Phone � P — t Address 7 20D 2J th icks-/— SSa C 19 PhonI IL talc Competency # Ins. Co. Address Address Permit Type (circle one): BUILD G ELECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN ai I I..r3 0IQ11r) krcjfr cJe\[reS Square Ft. Estimated Cost (value) 2 :15C 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 con . •n and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature of Contractor or Owner- Builder bi- .z Z4 Not to c " ()Q4- IoLOr � �:ui • :} I pr o ' N 0V 1g, ©2 3CoTF =v ,J MJ Building Electrical C.C.F. NOTARY BOND TOTAL DUE Date Date Plumbing Engineering