319 NE 101 St (10)�,j �7 / T Folio)! ,/ 2-(l . J 5' O P
Date % l �� Job Address 6 O,' ���� �
Legal Description v (pig I
g P / �J
Owner / Lessee / Tenant
Owner's Address
Contracting Co.
Qualifier /"Al°1
Date:
Notary as to O;n4i
My Commission Eip
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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/4,9
lgnature of caner and /or Condo President
FICIAL SEAL
LI0 ROBLES
ornrnission Expires
Or Cor*doe PrMMent
Comm. No. CC 205953
Zoning
Master Permit # `
Mechanical PlumbinK
Address
Fire Other
33/3? Phone
Signature oc Wptract
Date:
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Phone agr-r S'4%
State #, Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one ILDING kECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION s
Square Ft. Estimated Cost(value) / /,✓
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 AFFI► V .. : I certify that all the foregoing information is acc,rate and that all work will
be done in o•- ianc ith al applicable laws regulating constructio an • oning. Fu rthe ..•re, I
autt)ppriz = t , , ' abov me d c i tractor to do the work stated.
or Owner
OFFICIAL S
JU RO
uilder
Notary as Q r'r'aetkiTh qr g gilder
My Commissidtt• +ECpires:
FEES: PERMIT fi t ‘ 0 RADON C.C.F. / _4 NOTARY TOTAL DUE , 4 29
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Building &l� J ) ( 6 1,
`cam .___-- -
Engineering