467 NE 100 St (3)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
J o b Address 4V? A (C 4-f Tax Folio L 2 2 E 1 O m r7 4
Historically Designated: Yes No
Master Permit #
Legal Description
Owner/Lessee / Tenant)( 4Cil k ( OV t /1/16 . P L 33 J 3R
Owner's Address o w kl i
Phon () 71- .17 70
Address
Contracting Co.
Qualifier SS#
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION REPLACING KITCHEN CABINETRY AND KITCHEN SINK, ALL PIPES ARE IN GOOD
CONDITION, IT REQUIRES ONLY HOOK UP SINK.
/ GC
Square Ft. 24 - 6 F Estimated Cost (value) V4 2 2&
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 thework stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT RADON
APPROVED:
Zoning Building
Mechanical Plumbing
C.C.F.
S gn • - of ' ontractor or Owne -B iQ lder Date
poo — (CVO— V -6;26
Al
otary as to •ntra I Gr`� : ^ er- s J VILIAK Date
My Commission Expire :NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC7I4105
MY COMMISSION EXP. MAR 1 02.0
f7 NOTARY L� BOND
Electrical
Engineering