166 NE 101 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date a 9 9 7 Job Address / 0 f /t 1 E [ 0 ( St 'rTax Folio
Legal Description S Owner/Lessee / Tenant G L J 1 ' 0 1 1 4 (
ll y 5{'
Owner's Address /77 l d I S'
Contracting Co. 4.0 001/161 S
Qualifier
State #
Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING PLUMBING J MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION CA Pk N l �'►')Ct.s eC ,j &>
Square Ft. Estimated Cost (value) 9 J
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.
Signature of o and/or Condo President
k
Notary as to Owner and/or Condo President
My Commission ion Ex ices:
, c BRIAN M. THOMAS
z� �i► ��, COMMISSION # CC 657724
EXPIRES JUN 22, 2001
J ^ � BONDED THRU
4. 0F V - ATLANTIC BONDING CO., INC.
FEES: PERMIT3i ' 4 ' 9 .e 7 RADON
Date
1919
Date
Dr)
C.C.F.
Historically Designated: Yes No
SS #% Phone AI " 99 4
Competency #
Address
Address
Signa
Master Permit # `7 . c / 9
Phone 3 °5' 25 t — 561 /
Address 6(0/ Ce;v29f- --.rJ e.6'wtvraq
e of Contractor or Owner
Ins. Co.
uild Date
ri / /9 / 9 7
Notary as to Contractor or Owner - B uilder Date
My Commission Expires: o � P wv p ,, BRIAN M. THOMAS
Ii•I COMM ISSION # CC 657724
,r ^` 4r EXPIRES JUN 22, 2001 BONDED THRU
4 'OF Fe ATLANTIC BONDING CO., INC.
NOTARY -- BOND
TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering