269 NE 100 St (8)Date Si i / G S Job Address 2-6 J A/E / 0 — Tax Folio
Legal Description 2 / / 0 C S 7
Owner/Lessee / Tenant SG 6 ° ► C1 /e — ' A N. Master Permit # 3 i
Owner's Address 2-69 A /
C ` 6 S Phone 7S -4 7 1-- e,2
Contracting Co. WO rw g .:7w eV LF ( Address
Phone
State # r ( Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION PC-'/14 6 VFW la
Square Ft. /lo� /G
Signature of owner and/or Condo President Date
5
FEES: PERMIT 7 - RADON
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
- I)
2 Al 6s L,/, L.
Historically Designated: Yes
H' Te 7 -/ cs J
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
Notary as to Owner and/or Condo President Date Not
My Commission Expires: My
Signature f Contractor or Owner- Builder Date
C.q iev T S
6
Iigifk NOTARY SEAL
SANDRA M MONTIEL
* COMMISSION NUMBERS
��F a CC401261
No
C.C.F. NOTARY TOTAL DUE 6 13
Date
p": MY COMMISSION .EXP.
OF P.M AUG. 17.
o a bV
APPROVED:
Zoning 1
ing Building � Electrical
Mechanical Plumbing Engineering
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