136 NE 101 St (12)Date • 20 Job
Legal Description !
/ Tenant
/3 416- /O s� S�� - /`�i'as.�• S/�ovs Phone(301) /03 _ 2 732
Contracting Co. 19 / i9./) L, l 577'OCj A Z)� ,O C.2/VCkddress g /j/ s 4J 93 Cr. **a - �7: s 3! ?�
Owner's Address
Qualifier 14� /G FW.6 J 74 ` / — Ai//S SS# - cf
State # C 7 /CcPMunicipal # Competency #
Architect/Engineer Address✓
Bonding Company M l e Ad / Q/ --
/�
Mortgagor M. A /. l� Address
Permit Type (circle one): ; UILDIN LECTRIC t LUMBIN MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
`-- �/� _ d„ b.0 �,¢ccJ olk t wait/ /poor X Rd Y[P r _ s/ rat C MJAGC q i � oa r Ai c� — M v N S ` TV C ) I*Q. I
Square Ft. 5 U sr- Estimated Cost (value) # 5 " —
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.
1.4v ire �1Tarl 0 3 - v °
tore Mo . er and/or Condo / Piden Date
t7
/9 - D
Y J/ z. ,> 3 - 2001
Notary : o Owner and/or C do President Date o : : s to Contractor or
My Commission Expire st -•�•- NOTARY SEAL My ommi + y es. A / ' d
GLADYS) VILI AR . r / /�
NOTARY PUBLIC STATE OF FLORIDA * ' i J * My Co, mission CC581753
COMMISSION NO. CC7I 4103 �'�i " ` o� Expires Sep. 02, 2000
���
MY COMMISSION EXP. MAR. 12002 op 14.t
C.C.F. 1 ' O NOTARY 6 - . BOND /) -.
TOTAL DUE 4
FEES: PERMIT (.V. RADON
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
/36 /l/ /0/ s ' Tax Folio
// 9L 1 tC
friO F o( Historically Designated: Yes
L -37.06 . L o w , ,
�y0 TJw -i.
Building* lictloy,
Electrical
No
Master Permit # I /6. 3 V2.
Ins. Co.
<
Signature of Contrac, o Owner- Builder / Date
i
Plumbing Structural Engineer
or
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No.TH S:AST > 101 fT , .SurrieeT
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