319 NE 101 St (3)Owner's Address
OWNER'S
be don
autho
FEES: PERMIT 1a
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date //VW Job Address 38 "A % /0(
Legal Description'"`(C h1 dke s Sec 1 04. n V
/ l
Lessee / Tenant c 4 ka
3/g tc (o( sf 1 c
Contracting Co. °L) VIP
Qualifier SS#
State (r` Municipal #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one)): BUILDING ELECTRICAL ( PLUMBING MECHANICAL ROOFING PAAVING FENCE SIGN
WORK DESCRIPTION Y-� Ir C��.1 (,c +LPG 1(tU, Lk1-6-
Competency # Ins.Co.
Square Pt. Estimated Cost(value) 26 — O
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.
FIDAVIT: I certify that all the foregoing information,is accurate and that all work will
comp$ance w' h all applicable laws regulating cons ctio and zoy ng. Furthermore, I
bove- nddied contractor to do the work stated
f owner and /or Condo President Signature of Oefiet104i0paet Owner- Builder
Date: y Date: `NW
Notary as to Owner and /or Condo President
My Commission Expires:
*
RADON C.C.F.
Notary as to
My Commissio
Zoning Building
Mechanical Plumbing_
Tax Folioff-g 06 - 0(3 r f)UU
I b 70 lob- 16 61k 3
Address
Phone
Master Permit 4E -11�
Phone 7P 7066
Po OFFICiaL NOTARY SEAL
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66
I iB�rty �
4 CC55237
(' MY COMM'SSION EXP.
O 1 0 - • i7. G / 1O97
r
R **
NOTARY 5k TOTAL DUE/ $
Fire Other
Electrical
Engineering
13'
DRoL)- 4
1
101 ST.