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55 NE 100 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE • Date x/`476 Job Address s /007: 57 Tax Folio // 3 2 -0/3 - ZD Legal Description SEC / /P- E12 / 7 ,L w /9 Historically Designated: Yes No �3 99'06 q a3s Owner's Address SS NE /OD 7 ''' S T. Phone (345) '756 "©/6 5L Contracting Co. tr9v4 A( Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer TPe%/E) . e< E.L.)vs — Ey /Address Z //..S S • yt'd r& r ZEfe/O4V 5 Z4 Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL (PLU ROOFING PAVING FENCE SIGN WORK DESCRIPTION / T ? / AECZ . E p ls9o2)EL ` , p/Pg O w n e r / L e s s e e / T e n a n t / 4 E & E D U S , 1 Kl A N Master Permit # Square Ft. Estimated Cost (value) ; ' 2, .ce0 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 th � work stated. te r-- �_�._.� / °.� S e of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: APPROVED: Zoning Building Mechanical Plumbing Contractor or Owner- Builder Date Notary as to Contractor or Owner- Builder My c1ommss E7{ re�' _= y 00,1 IAL wo - rAnv OZAL °Ano A M L 7®C�YIUL Tett uo mission c ' kte CC401261 e '', , cav coun{snION 'EXP. � QI 1;\P Atj21: 17,,1008 FEES: PERMIT -2 )tr i RADON C.C.F. ); ` NOTARY cS^ BOND TOTAL DUE €/ Date ���e� bey i Plzo AVA -r°ot y PA- ,1Q e i' N'c roiLer 3'' PVC itke..pe te off° 0 , RT-tir EL EVA n ALL J LU to I TA s Aac Neer_ 241/Aroe , , iffit 'tme g ,g® rmA'&s- 1); Tv cri.+ee eAVA eroo + k riZ N 0 EPitVr 70 LE - VA - no 0