334 NE 100 St (10)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1 2) a-'/ 1 aq Job Address \/ 33 L( 1V = F-• 100 Si Folio
Description Historically Designated: Yes No /\
/ Tenant y ci pt N R. C R I F F h AO Master Permit # 400?
Owners Address 33 Li M E • f CO T L S I tee,/ Phone c?e,s 7 s iO t1
Contracting Co. 81 AtYLQf (J Address DA 1/407A-e_ P 3o S) .Go ^ Q q
Qualifier e i ' ss# Phoned 3007s
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address 206
Mortgagor Address
Permit Type (circle one): (BUILD G) ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION' � �(�t eY.LITtt2 t o ft CAF P +1/4-$CE
Square Ft. Estimated Cost (value) 4 S 00 -
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR DIPROVEMENTS 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.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date Notary : to Contract
My Commission Expires:
My Commission Exp
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Date
FEES: PERMIT RADON C.C.F. ' r' 0 NOTARY S BOND /
APPROVED: TOTAL DUE_`
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Zoning Building Oil i`1 Ib Electrical
Mechanical Plumbing Structural Engineer