77 NE 100 St (8)Date 1 Job Address - 1 - 7. IV . L . loo 64a'eaf
Legal Description GAT .. gr G✓,L .2 /
Owner / - Lessee- / Tenant 411Zor N `1oer3 S P .
Owner's Address 11 N . & . 1.00 - t-s-ee3t
Contracting Co. 4 ouuv6yr
Qualifier
State # Municipal #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle o1 ): BUILDING, ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION (u/ad le Cabah
Square Ft. Estimated Cost(value) $ 2 G o e.
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 c onstruction and zoning. Furthermore, I
authorize the above -named contractor to do the work s
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * *
FEES: PERMITe74
APPROVED:
Zonin
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Address
SS#
Competency #
Tax Folio // .3 26 /3 / &'/
A /P Sec
Master Permit # J.5 / (�
Ins.Co.
Phone - NDS . s l - Hz9,
Phone
N:' ary '= s t
My Commissi
Contractor or Owner- Builder
93
* * * * * * * **
RADON C.C.F. NOTARY Q0 ,e e TOTAL DUE 4g
Fire
uildin
Other
Electrical
Mechanical Plumbing Engineering