444 NE 100 St (13)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ��d/ 7 7 Job Address ( 7/ VY' /t / O1c J Tax Folio
Legal Description Historically Designated: Yes No
5ILe.essee / Tenant /Zeeden Master Permit # 4 1 e
Owner's Address 4 /V C/ ist/ /6 ' Y Phone 7-r ?Z /G `
Contracting Co. 6 A6n r �2 j �G 610p0/lz- Address 224/ M& F /9/ , 1../17/1 '
Qualifier 1C i i'af -
S t a t e # g d!9 Y" 9 dJ Municipal # Competency # l CW-C Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ' OOF 1 PAVING FENCE SIGN
WORK DESCRIPTION ,�;,e�+ -- //Col C.O7./K -07../K ./f+j /Z
j eer/0% 44 ' Itz". /7 CC e."7.4(.02"..,
Estimated Cost (value) mot/ /AS 0 J
V V4
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.)
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 accurate and that all work will be done in compliance with all applicable
laws re plating c nstruction and zoning. Furthermore, I authorize the above -named contra ctor t. do the work st
oir / j 4........./
Signature owner and/or Condo President • Date Signa • �'• t or • er- Builder Date
F Orud J2360 C(0.0
Notary as to 0 ' er an• or Condo President
My Commission Expires:
FEES: PERMIT
CAROLYN C ROBE
My Comm Exp. 5/08/99
onded By Service
No. CC46065
t 1 r�o..ur IDIOM Novel B►
RADON
C.C.F.
ss# / - Phone 1 4 9 2., i/T
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
NOTARY BOND
TOTAL DUE bi
APPROVED: 1 ,'
L Zoning Building V Electrical
Mechanical Plumbing Engineering