1490 NE 101 St (10)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 9 � Job Address / 4 0'/�� /G / A d Tax Folio , / - ; �✓
Legal Description `P' 11 \I
Owner / Lessee / Tenant '1 a S4
Owner's Address /
/ l) /AE // di
Contracting Co./10' / //- a)Y& !7lf/✓ Address / 7"/ 7 " /V
Qualifier�� '�J��4 / SS4�� (,,
Phone �/�� 3%Z 4
State # *OD
Architect /Engineer
IV
Municipal # 9397 Competency # Ins.Co.,/ 20
Address
Address
Bonding Company
Mortgagor Address
Permit Type(circle one)• BUILDING ELECTRICAL LUMBING IC ROOF G PAV G FENCE SIGN
WORK DESCRIPTION ,7
Square Ft. Estimated Cost(value)
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Master Permit #.1/
Phone
"74/)
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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 stat )d �/ /
G�xLfri '/? i�'Lia- -1112
Signature of owner and /or Condo President Signat re o Coractor or Owner- Builder
Date: Date: 7/02,3/ n't-
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * * *
APPROVED:
Zoning
as to
My Commission
**
FEES: PERMIT ' RADON C.C.F. 1 ' NOTARY ? VOf3 TOTAL DUE5
Fire Other
Building Electrical
Mechanical t 9 7 Plumbing Engineering
4(t ?6
6rov
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