361 NE 100 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Addres f 3 (1 M I. () O �T Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant) p A-TR WA& F LP Ern ff
Owner's Address 3 fo / 4/6 e / D' $ 3-
Contracting Co. �91.)
Address
Square Ft. Estimated Cost (value)/ "l 1 S
Master Permit # 46 9'6
Phone(30 5 - 1 2- 'I
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one) : UILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING ) 4
PAVING FENCE SIGN
WORK DESCRIPTION( �h (1 Gir ! 14) vi
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 owner and/or Condo President Date
Notary as to Owner and/or Condo President Date Notary
My Commission Expires:
FEES: PERMIT
RADON
Contractor or Own- Builder at
My Co
ctia
ntractor ' r Owner - Builder
C.C.F. ' " NOTARY S BOND
TOTAL DUE
OFFI NOTARY SEAL GLADYS I VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION O. CC /1410
MY C EXP. MAR. ft j
APPROVED:
Zoning Building dr1 Electrical
Mechanical Plumbing Structural Engineer