253 NE 101 St (8)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address (J ` 3 A . /01 Tax Folio / 13,2 0(e) c / M0 •
Da t
Legal Description
Owner / Lessee / Tenant 5_ V f'_. 9J /<2.11 (7V2./r) Master Permit # 1 /),10
Owner's Address p�S� AJ E . /D/ „5-1.
Contracting Co. n 03 /QA Otr Q
Qualifier ),QC 9 /o D Orr SS4t
V
State #0(R/45 Municipal # Competency
Architect/Engineer
Company
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Permit Type(circle one :'BUILDING ELECTRICAL
WORK DESCRIPTION f \( O In Y I 0 I
Phone 7 S 1 -' A
//I /. /`, Address Joi F/ Q fer
rGr-� /
- - Phone 3t, )c —bn I- (O0�j
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4r m/a'4 Ins .Co. l ob. (c
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r Address
y Address
Address
CHANICAL ROOFING PAVING FENCE §IGN
Square Pt. Estimated Cost(value) 5 0
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,
authorize the above -named contractor to do the work stated.
Si
Date:
Not
My
** *
y as to Owner and /o
ommission Expires:
APPROVED:
owner and /or Condo President
* *
*
^.N14 M. SHERRY
efltce Ins
CC597112
( 1 Personally Known l 1 Other I.D
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/S gnat
Dal = •
. SHERi '
; r oar tit , der
No��ary as to Con ��
Bonded hry e
No. CC59 112
ilFersoaMOrtoemllOthv
My Commission Ex
6,„
ractor or Owner- Builder
*
*
*
RADON C.C.F. t( 1) NOTARY TOTAL DUE
Fire Other
Zoning Buildin
Mechanical Plumbing( ' N J Engineering
Electrical
BUILDING
UMBING
CTRICAL
O OFING
O w ner of 2
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
❑ DATE — / 195 f.
❑ PERMIT 'N? 11111 Contractor's
License No
in Work to be performed under this Permit
j A 1
CONTRACTOR OR BUILDER
44 7 21 1
Bl.
Signed•
Subdi-
vision
Value of
Project $
C 3 ' / b / ,,.. ,
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device descri d in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in comp ance 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 wofk 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 i the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
INSP
��"•�z.,�,.s:� - ate`
Amt. of
Permit
BY ) .
AUTHORITY
In consideration of the issuance to me of this permit I agree to rform the work covered hereunder in compliance with all finances and regulations
pertaining thereto and in strict conformity with the plans, drawings ements or specifications submitted to the proper authorities of Miami Shores Villago
In accepting this permit I assume responsibility for all work don either, myself, my agent, servant or employee.