144 NE 101 St (12)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 574797 Job Address / 4 / ,v&la Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant in /47.77/ 5 40,- C ' j •2L 1 fi7AN C 4 ✓a) Master Permit #
Owner's Address /Dire N 1 �'- ,y Ave_ Phone , 0 3 > 7 $ 9 e '/
Contracting Co. d &V WE. 2 Address
Qualifier SS# Phone
State # 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 / 5 T - A 1 / , — 7o4/ D1G G 4 44 ,�V Li•v�
iO' 7" �i , y ,4 •
Square Ft. Estimated Cost (value) °
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
laws re ting construction and zgning. Furthermore, I authorize the
ufe of owner and/or Condo President Date
FEES: PERMIT L ` (/. RADON
Notary as to Owner and/or Condo President Date
My Commission Expires:
C.C.F.
APPROVED:
Zoning Building kW6
Mechanical Plumbing
is accurate and th :. all work will be done in compliance with all applicable
above -nam - tractor to do the ork stated.
/i ,� .miraio' i111P
e of Contract. or Owner - Builder Date
Notary as to Contractor or. Owner.- Builder ,,
My\Conimission Expire ;o5'G1"i■ C7
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Y ltW c;c1 :::l :rm. .17. i
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I 2
NOTARY O. BOND
Electrical
Date
TOTAL DUE iV r
Engineering
Sr e.
5Th\i,
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CS 8 �
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