55 NE 100 St (16)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
D l x/ 6 Job Address 5 5 NE. 100 St Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant N or fmox A. 14E_Gr.....bu S , Master Permit # 063
Owner's Address
57'4E 100 St. Mini dior i, F1.33138 Phone (v1.9 756 — O/ 6 t i
Contracting Co. OO NI E Q, Address
Qualifier SS# Phone
State # . U�.46KA, Municipal # Competency # Ins. Co. /,, r� sj
Architect/Engineer JQ . & raj 1 re_o. Address 1 541 2, .{3,[X, i � e r 'h a R. 3gig ,t
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION i s10.1ICCt On O f ,rer,(„3J OW NS ALwiltS Wa. I Li & ,& 5
ALu mculo, Frc* w t A U
Q �
Square Ft. 21 s 'l"' 12 5 't" 1 S 2. S • Estimated Cost (value) (.S a
WARN
RESULT
CON
Applica tallation as indicated above, and on the attached addendum (if applicable). I
certify t all laws regulating construction in this jurisdiction. I understand that separate
permits . OLS, ROOFING and MECHANICAL WORK.
OWNE
laws re
Signature of own
My Commission Expires:
Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder
My Commission Expires:
APPROVED:
Zoning Building l 1 p
Mechanical Plumbing
E OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
FORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
on is accurate and that all work will be done in compliance with all applicable
the above -named contractor to do tl work stated.
Signature ontractor or Owner- Builder
F
FEES: PERMIT 4 / 0 ' RADON C.C.F. ( NOTARY <57 BOND
TOTAL DUE
Electrical
Date
Date
Engineering
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