157 NE 101 St (9)Date J?),-, /1/ 1 4 Job Address J57NE /0/54. Tax Folio
Legal Description
R.)<Eiz -H 5 FO
Owner's Address /, j 7 NE 16 r ,$ Phone 7,s y - Li q/.3 33357
Contracting Co. , j , yu Address 110,3571/1v' 3
r "rj
State # Municipal # 'QY-) 3y3 74 `� Competency #0270)44/5 Ins. Co.
Qualifier
Owner/Lessee / Tenant legs
Architect/Engineer
Bonding Company
Mortgagor Address
WORK DESCRIPTION
r �
S��a e (owner and/or Signs e f owner and/or Condo re 'dent
FEES: PERMIT G i 9 RADON
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
.r
?p?
Notary as -to Ow tei -gsldent
My Commi {)✓'xp',e; ntiA ra nOwnE6
• COMIISSIOFI F1UMman
3' CC4012 1
MY CMMIsSION •EltP.
OVA 171f116
Date
Historically Designated: Yes No
Phone `7lS•,-'c -7y4,--56 A1
Master Permit #
.,
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost (value) /(, / /<�cv
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO NAY
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.
�—�
lure of ontractor or O er- Builder
Notary as to Contractor or Owner- Builder Date
My -onim ssion=
, S Y PO OFFICIAL NOTARY S :AL 1
O 0. % SANDRA raONTIEL
* COC1r9ISSION F1U( )LLIA
' , Q CC4O1221
COI^.r.9I�:=: 11 •' xp.
C.C.F. -C NOTARY TOTAL DUE 1.1.- r `54
Date
Building - 'If 1 ` t" Electrical
Plumbing Engineering
BUILDING
ELECTRICAL
PLUMBING
Owner of \
Building
Architect
Contractor
or Builder
Legal Lot
Description
Y
MIAMI SHORES VILLAGE, FLORIDA
DATE 194
PERMIT N? 4815
Contractor's
License No.
Work to be performed under this Permit
Bl.
Subdi-
vision
Address of % - `_ -,
Building i ) \ .• i i ..
This permit is anted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Value of
Project
Amt. of - 4 -
~
Permit -
Signed • By
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the wdrk covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting i- .ermit I assume responsibility for all work done by either myself, my agent, servant or employee.
CONTRAC • R 0 BUILD BY AUTHORITY
BUILDING
ELECTRICAL
PLUMBING
Owner of \
Building
Architect
Contractor
or Builder
Legal
Description
CONT A +R • ` B ILD
MIAMI SHORES VILLAGE, FLORIDA
DATE C9 L Y
PERMIT N? 4815
Work to be performed under this Permi
Bl.
Address of i 1 Value of
Building S 1] � . Project
This permit is g anted to the contractor or builde named above to construct the building or to install the equipment or device described in the appli-
cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work wil be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed • By
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accept' t..is .ermit I assume responsibility for a work done by either myself, my agent, servant or employee.
Subdi-
vision
BY j p t ` :
Contractor's
License No.
Amt. of
Permit
194L
• Li J AUTHORITY
(5)-