398 NE 100 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1 4 0 VPY , Job Address 378/I/ Tax Folio
Legal Description Historically Designated: Yes No 1
Owner/Lessee / Tenant ," . �r� // ve/7 Master Permit # ! JJ aZ 75 /
Owner's Address ‘ 5 ° '49 ////
Phone Z% - 7 ? 3
Contracting Co. GC Address re 4. •� v 'Q :-, �h /Y�s.,�' �o., Y
/�/ 4/1"., / _ 33 /4'0
Qualifier v( �y SS# Phone 726'f
State # Municipal # Competency # ����� >�Ins. Co.
Architect/Engineer Address .5 `�,6
Bonding Company Address /%o� -•,i. ����� / L
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost (value) /zi ®®
/ ft
Signs ' e of owner and/or Condo President // Dat
otary as to Owner and/or Condo President
My Commission Expires:
FEES: PERMIT 4 RADON
Date
C.C.F. g0
o e. SAPac 4 MON
iz 4. COMMISSION NUMDEN
'1' Q CC401261
9, % PAY COMMISSION •EXE'
v OF F n 4 AUG_ 17,9fIn
NOTARY 5. D &
c9S 72,
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 OF 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 Contractor or Owner - Builder Date
otary as to Contractor or Owner - Builder Date
My Commission Expires:
BOND
TOTAL DUE 4717. 3r
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering