1431 NE 101 St (3)4
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91080
PERMIT APPLICATION FOR MIAMI SHORES
Job Address ) / N / 0 /S Tax Folio / l ' o`(/ sJ 24- O C J
Date
Legal Description
Owner/Lessee / Tenant X
Owner's Address
J
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Contracting Co. CO m 19 rLA -0 1 P 4/c-
Qualifier () E C ►) o
State # C CC. Sr/o c 3SC Municipal #
Architect/Engineer
Bonding Company
Mortgagor
X
9-
Signa ure wner and/or Condo P sident Date
/,g -789
otary as to O
My Commission
FEES: PERMIT
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Y PUBUCSTATE MORI
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2002
RADON
Historically Designated: Yes No
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C.C.F.
ss#
Address
APPROVED:
Zoning Building
Mechanical p
Master Permit #
Phone 757 — 8o 7/
21 20 5u) g2 Ave
2,63 - 9/ - O /33Phone
Competency # Ins. Co.
Address
Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION (/4 P N U E c u $ I o ti Sy sTel'A
Square Ft. Estimated Cost (value) 2 \a 0 00
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.
tary as to
My Commission xpir
NOTARY
Electrical
t%1NOTARYSEAL
GLADYS] VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2002
BOND
TOTAL DUE
• J/ 1 r Plumbing Engineering