320 NE 100 St (6)t '!
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date -3 -P° Job Address 3 ✓ • 0 • /0 X3`7• Tax Folio
Legal Description Historically Designated: Yes No
OwOwner/Lessee /Tenant - d 2 01>o,g. L Master Permit # 1 7 )
Owners Address
Contracting Co. / •• A . F . U, 1 d R 5 , Iv z • Address
Qualifier .4 L F / ,z ' A 2l
State # G fz C - 059/0/ Municipal # Competency #
Address
Address
Square Ft. Estimated Cost (value) / 000
e of owner
or ondo President
Si' . ,>
Notary : , : %'t' and/or Condo President Date Notary as to Co
My Co ssion Expires: My Commis
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-� 4 4
t� o NULL FERNANDO FORNARIS D. ��y
COM 642153 ` MISSION # CC a V ' 544A _ 0 EXPI RES APR 27, 2001
BONDED THRU
OF W ATLANTIC BONDING CO., INC.
FEES: PERMIT RADON C.C.F. 3.6D NOTARY
APPROVED:
Zoning
Mechanical
9/
x - co
Date
Building / / Z)'' u,'
Plumbing
Phone
SS# Phone 7 36 -4 ,
Electrical
Ins. Co.
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION II o KirG* -, i Li AD , e -w -( o, t ' Oc)s - 4 . t ( is - 4,
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.
BOND G D
TOTAL DUE
Structural Engineer
lab
.149 30 0t- tD0-T
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