431 NE 100 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address /1) Am 67 Tax Folio
Legal Description Historically Designated: Yes No
Master Permit # '0 3
Phone '76_ 2 S 7 s y `,� 6i �)
Address aC3 oCiw a 76
SS #
Date aL
/
9 /Lessee / Tenant 2,ROZ)c 2E,Q /42S Oa)
40/ Af /0051
Owner's Address
Contracting Co.
Qualifier 3/ G' /59 • ��' .47Z
State # l' A'0.0 l9' h, 21 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address_ -- ---
Permit Type (circle one): BUILDING ELECTRICAL PLUMB i G MECHANICAL � I OOHING PAVING FE CE SIGN
WORK DESCRIPTION
i ll
c
ors
Estimated Cost (value) /, eo
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 (1F YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Square Ft.
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 accurat and that all work will be d
laws regulating construction and zoning. Furthermore, I authorize the above -n
Si air of owner an
j i. My a's
FEES: PERMIT'
APPROVED:
Zoning
Mechanic
•r Con 'o President Date
-4
.• -► r •n• •
a�• o
p es:
RADON
OFFICIAL NOTARY SEAL
VIRGINIA AQUINO
NOTARY PUBLIC STATE OF FLORIDA
P. MAY 6,1997
C.C.F.
41, 'Teri; IffiraPalreri 1
My C� xpires:
d contr. • •_do the wor
Building
O F CIAL OTAR FA
NO'T'ARY PUBLIC T FSTAO
`•` • .CC2
uktieCOMMISSION EXP. MAY 6,1997
•
wner- Builder
ate
NOTARY
Electrical
pliance with all applicable
TOTAL DUE 3 6,
9'
Plumbing Engineering