1421 NE 101 St (11)" PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date a ? ob Address / q oa ! IJ' / 0 ( $r Tax Folio ,/ 3. .24J 0 ta2/0 c)
Legal Description /c - 6 /-'---C‘ -y.� G4.
Own / Lessee / Tenant mil ( dr / 1 i t50-! Master Permit # , g�7b
Owner's Address 1 ' Z ( A) C 0 ( S'r Phone 7 / P_
Contracting Co. T) LA- e r Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company t Address
r
Mortgagor '�l — Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN \,)
WORK DESCRIPTION C� -�-,� � +-�-
� � U
Square Ft. Estimated Cost(value) 440
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.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** *
APPROVED:
Fire
Zoning Buildin
Mechanical Plumbing;
f2124-,‘
Signature o
Dat - �'
actor or Owner - Builder
P(, OFFICIAL NOTARY SEAL
SCOTT DAVIS
} M
'
Notary as to dr�r oiC0 6gaguild
My Commission e Q`' . NAY COMMISSION EXP.
' JAN- 26 1997
* * * * * * * * * * * * **
FEES: PERMIT �o RADON C.C.F. ,1.3 NOTARY 4.5: TOTAL DUE /275
Other
Electrical
Engineering_
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date S 0 r %Z Job Address
Legal
Description Go77 i ,51,: 3 /.f.1.04 7itle es?: /j 4TL)
Tenant P V6/V f it/
/ y)- J , f/ / /.I7
J � 1u, 4479-4)
Owner / Lessee /
Owner's Address
Contracting Co.
Qualifier
State 4# 6 t I))Ili/J Municipal 1
Architect /Engineer
Bonding Company
WORK DESCRIPTION
Square Ft.
APPROVED:
Zoning
' /O /�/e /O/17 Tax Folio // 33 J ®?'ft 42 0
c) f F) n�1 lc DOE /ISit -
Address
Competency # Ins.Co.
Address
Y Address
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
* * *
FEES: PERMIT 'X . 66 RADON
Building q 44---
Address
e r 71A-7-
ce7 Estimated Cost(value)
Master Permit it V ' 2 ?
Phone
34.4 (//- Out
Phone 6 33- 5 VA
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
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.
Nota as to ContractoAor Owner- Bililder
My C ssion Expire -,�
NOTARY I BLIC, STATE OF ?LoRIDA.
MY COMMISSION EXPIRES: Dee. S, 1995.
BONDED THRU NOTARY PUBLIC UNDERWRITERS..
* * * * * * * *
*
C.C.F. NOTARY TOTAL DUE -
Fire
Other
OU fr9
3 � /.��/z 6/a'
Electrical
Mechanical Plumbing Engineering