301 NE 101 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date (9 -1? -"l ! Job Address 3 6 . 10 ( Tax Folio
Legal Description -(,, m r ,Shore5 Spy' / lest' Historically Designated: Yes
l3�ly B1t38 7oLr'o t/- 32.96- O/3 -5/
Owner/Lessee / Tenant . " l N e - ticz j r�/� +` . Y Master Permit #
Owner's Address "0 / / C / cJ st v
Contracting Co. fl 0 r /
Qualifier N iek (a S Se , Lin
State # ('j( ) 10,5" Municipal #
SS#
Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRIC
WORK DESCRIPTION
ignature of owner and/or .P ndo President Date
i ? 7- 5.5 yt68'.t
Notary as to Owner and/or Condo President Date
My Cpau • ssrortZx a -o�—
pyB, CAREEN A. HUTCHINSON
° = MY COMMISSION # CC 648710
d ra
n;, r
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:,,��,,, EXPIRES: May 19, 2001
'AR Bonded Diu Notary Public Underwriters
FEES: PERMIT B3''RADON
-P7
Address ! QCZ
456 /.3
No
Phone , ?0 - 5 V - KO
Po eAne / 2 ee0%eloI
Phone ecs -- 67e/- 777O
Address
Address
LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
/h 97' /i (c to I1&' d._ge #leery% #-
el.lelf,'n � y� j ( n - zw /A 8201 ,
Square Ft Estimated Cost (value) i /P9 ' '
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 work stated.
C.C.F. Z NOTARY "' `' TOTAL DUE
APPROVED:
Zoning
Mechanical Plumbing Engineering
Building
Signature of Contractor or Owner - Builder
Electrical
Notary as to Contractor or Owner - Builder
My Commission Expires: S/{' /a -o..4:4
.......... CAREEN A. HUTCHINSON
�'•' = MY COMMISSION # CC 648710
•.,,•, ' ° ' EXPIRES: May 19, 2001
• .,g p F g.• Bonded Dm Notary Public Underwdters
/ Or-9y
Date
Date