487 NE 100 St (9)5'7A718-17 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 48/ 7l • ` O O, ' Tax Folio/ ( 5 2 Of 74C -5 <Z"0
Legal Description
Owner/ Lessee / Tenant
Si
Date:
•
My Commiss
** *
FEES: PERMIT
APPROVED:
Zoning
417
/ - ecr7„Ttio-?
_ /=2'2:44.
Owner's Address
Contracting Co / / ♦. Address
Qualifier p �
S,:ace 4 :2T ® 40 � oa Municipal Competency it
Architect /Engineer
Bonding Company
Mortgagor
Permit Type(circle one): BUILDING
WORK DESCRIPTION
Address
Address
ELECTRICAL 'LUMBING MECHANICAL ROOFING PAVING PENCE SIG
6
Master Permit If
Pho e
Phone !,5 7 —' 7
Ins.Co.
Address
Square Ft. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO L
30 MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEN
TO OBTAIN FINANCING, CONSULT 4ITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, ar
on the attached addendum (if applicable). I certify that all work will be performed to meet t`
standards of all laws regulating construction in this jurisdiction. I understand that separat
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 wi:
be done in complianc - th a 1 applicable laws regulat ng,const ction and zoning. Furthermore,
author e the abov med ntractor to do the work stated.
of owner and /or Condo President
on
O;dip
re FFICIAL NOTARV SEAL
ee„ SARINA M HIRSCH
f
0 couMISBION NUMBER
Q CC714091
a 0 WY COMNdSS1 I EXPIREit
OF ‘. O MAR, 1 20
m0
A.or i
Notary as to Owner and /or Condo President
RADON
Mechanical
*
Building
Signature of Contractor or Owner- Builder
Date:
ctOUBER - TCOM PLB
O �� 7► s :COMMISSION NUMBER
en d � L'g CC679543
'' S SI0N EXPIRES
O
�� spa. MY 11,2001
Notary as
My Commiss
*
ilder
*
C.C.F. 1 6 D NOTARY TOTAL DUE
Other
E l e c t r i c a s�/�iS�i l�.via
Fire
Plumbing_ Engineering