312 NE 101 St (7)Date * Job Address Tax Folio
Legal Description Historically Designated: Yes No
/ Tenant b &),4i(2D / /40,(244 °/y Master Permit #
Owner's Address 3 Z N G . , 1 0 ( S T. If Phone 3405 75 — 77 7 6,
Contracting Co. (, 2. M �' 1'i� 3J C , Address ZI 2.S N . S
Q R /0 At= bet1A4, 5 SS # - 32 S 3'7764
State # • r AS016 y 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 3C>, . s y f �
Gon•-11241-■ a Di7- ? 5
S °°
Square Ft. Estimated Cost (value) C)C) '
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
Signature of owner if d/or Condo Pr _ _
L , 02o � 3'7/ 7 - . 7 � -9y
L
tary as to O er : �'r'ondo t' y r • 1..� r-
r I VIL
NOTARY PUBLICSI'ATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2002
My Commission Expires:
/E
FEES: PERMIT ? RADON
Jr)c.- - 77s -7 G cot,
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
a tujg o .. ontrac or or O ,'�:
Notary as to Contractor or Owner- Builder
My Conunission Expires:
C.C.F. • 4 NOTARY BOND
uilder Date
762 3 -5.3 y4'4/-
Date
6d
TOTAL DUE. T�
APPROVED:
Zoning Building Electrical /1Z/Z,'
Mechanical Plumbing Engineering