315 NE 101 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date "7 / /9( Job Address , - 9 /6 — X4/12/ 37 141,202;61/10 /2 Tax Folio 1/ ) c7 (9 (r) /3
Legal Description J / /9- /` ' G' `t d6j Flistoricall Yes No
Owner/Lessee / Tenant `��i- L(/ Master Permit # - �,�
Owner's Address r 3/,' )���p /� / `��� / ' L��� P17 .- 2ST / 3 7
Contracting Co. t ° o= • • h// / ✓ 62�7 Address 3623 C Oc"r/mom �•-• P4
Qualifier ?fr / 'i 9 SS# 3C25 - -AC - ' 2 G 3
State # Municipal # Competency # 7c'IX "J ?Sins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
'71.J A -Y/
Signature of owner and/or Condo President Date
Ndtatry as to G�vner and/or Co fido President
rr,, JOCELYN L. POPE
:.: a :r MY COMMISSION 1 CC 497184
le' - 1' EXPIRES: February 6, 1999
�` Bonded 'Nu Notary PubIc UndennlJen
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON
Building
2 //,
ate
C.C.F. NOTARY
Electrical
oo
Square Ft. Estimated Cost (value) 4 52 5 -9
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.
Sign a of Contractor or Owner- Builder
N•tarvas to Contractor orOwner- Builder
IyfY c�tdrrr}� ion sxpiresr:: ,v
TOTAL DUE '
Date
Plumbing Engineering