277 NE 101 St (10)Owner's Address 211 AD S 0
Contracting Co fjA)
Qualifier
State # Mw
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one)
FEES: PERMIT D RADON
PH -171
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0
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 15 \1^ � Job Address/ 27? /OE 1 0 ST Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant V l t o 100 eo ULLZ) Master Permit # V g 0
Phone)( 3 5 - - 1 5
j P'1
chalk white
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION t N 1 (3 ELL 6
Square Ft.
Estimated Cost (value) )e
1
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 wo_k s : ed
Signature of owner and/or Condo President Date Signa � a .f 'o• a or : �'i Builder ate
Notary as to Owner and/or Condo President Date Notary : s to Contractor or Owner - Builder Date
My Commission Expires: My •ommission Expires:
OFFICIAL NOTARY SEAL
GLADYS J VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2002
i—
C.C.F. ! I / P NOTARY > BOND
TOTAL DUE 3
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Structural Engineer
Date j D '- 2- Z- Job Address a-11 t 6
Legal Description Ea'
Owner / Lessee / Tenant e1.+2 ■
Owner's Address
Contracting Co.
• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Qualifier ( F
SS#
State # Municipal #
Signat
Date:
rlt t
tary = s to Own - r and /BscO6
Commission Expires: Type.II
DID rake an oath, or
�D1D NOT take an oath.
** * * * */" * * *
APPROVED:
Zoning
1 o
Fire
2 & k o \ S.� rti +t—M� S SE S . • Phone
e or stamp name of Notary Public
I nurn bcr profluced:
IV't rn ;) a v�
Phone
Competency #
Address
Tax Folio) fo d ) d%! ■J
Master Permit #3 ig
--1 S - o 39
Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor _ Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION E(1_ o P•A -•k..r 14 (. o ' ) c) L-
Square Ft. Estimated Cost(value) lk
WARNING TO OWNER : YOU MUST RECORD A NOTICE OF COMMENCEMEN'T' 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 abov= -na stated.
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * * **
FEES: PERMIT t.7 Z ) RADON C.C.P. f 6 0 NOTARY TOTAL DUE YAW
Building
lofjo
Other
Electrical
Mechanical Plumbing Engineering