131 NE 101 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Addres* / 3 ( WC /D/ 5'7
Date
Legal Description Historically Designated: Yes �) No
Owner/Lessee / Tenant , � eY / ✓ �G Master Permit # (9V 7g)4
Owner's Address Phone
313 -3 Soft Suede
Tax Folio
Contracting C `C.Q�rt c_o CO n 5 fry 0441).1 Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Address
UO0.II S ne): BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
IN
2/B
Si o wner'bnd/or Condo President Date
Notary as to Owner and/or Condo President Date
Notary
My Commission Expires: My Co
4 14,;:674..,, Veal t
FEES: PER MI6 D RADON C.C.F. " / NOTARY
Building /*/(
Estimated Cost (value)
Electrical
tkOd 7
V YO
iPR
'
313 -4 Earthy Cane
A _ _ ) 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.
NOTI ; I NCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
TR PR : OU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
7R N(. MMENCEMENT.)
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.
Signs i f of ontract• • • B, ider
1111111E 7 A11111
� �. .
• •z`
10N NO. CC714103
COMMISSION EXP. MAR. 1
BOND
TOTAL DUE T�
po re-
de
Date
APPROVED:
Zoning
Mechanical Plumbing Structural Engineer