230 NE 101 St (8)Date , t
Legal Description
Owner/ Lessee / Tenant - sc _ U rc� �I c-3\ c..
Owner's Address Z b j - Ipl Sf)
Contracting Co. VA L i o
Q -- Z - u 1 o G.
State# C,Ac.453Sug`j
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN
WORK DESCRIPTION 1
Signat
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
S6. Job Address 230 4,,A. . I(..; . Tax Folio
Square Ft. Estimated Cost (value) o U U .) . W
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
la_ regulating construction and zoning. Furthermore, I authorize the above -nam contractor to do the work stated.
Notary a• to
My Commissi
Personall
FEES: PERMIT
APPROVED:
Zoning
Mechanical
A/c t, vt c
1
1
n Expires: KIM .Ag1DA
NerIA Y PUBLIC STA.
CCiM'i•.'iI SIO NI NO. CC493698
S It EXP. SEPT 6,1999
Municipal # Competency #
Address
Address
Qb
Date
12/3/96
ate
Historically Designated: Yes No
Master Permit #
Phone QQ
Address ZS - 27 hl w: 1 J' .S-9 -
SS# Phone G _ IS to "
Address
3. 0
s
Building
Ins. Co.
OOFING PAVING FENCE SIGN
Notary as to Contractor or Owner -B der Date
My Commission Expires:
\P¢Y p4/ OFFICIAL NOTARY SEA
S" ; � BARBARA ANN FUGAZZI j
N qZ�� COMMISSION NUMBER
y } a CC360191
COMMISSION EF1r.
OF r4..
C.C.F. /1 NOTARY -5 BOND
Electrical
TOTAL DUE 05.30
Plumbing Engineering