802 NE 100 St (14)Date
Legal Description L b T it t W Y2 OC- (D Historically Designated: Yes No
t3t_rS l 69 P8 4 – 33 'tA( r I lard l-+Ure
Owner/Lessee / Tenant 0 (.V )■l r= CZ 4 b-t- C' 5 ! 2 f t Master Permit # /13
Owner's Address n`Z- N E. to OS' -r -3 g Phone 3 – '7 31 02-P1
Contracting Co. 1 - F — D u' N /= 2 Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one : BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION (. NS T )9 L L L E M D V)R S L F _ L v n n ) N Lim) S 7 , ( ' - ' S l u T -r r_ 1.3 g
Square Ft.
0
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 the work stated.
l '14A'LtIt
Signature of owner and/or Condo President
Notary as to Owner and/or Condo P esid t
My Commission
FEES: PERMIT
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address S d' j ,-. j rosy Tax Folio
sic E ry Estimated Cost (value) ft b 0
Date
tPRY pU IAL
OFFIC NOTARY SEAL
O
4"<i BARBARA ANN FUGAZZI
2 . 1 { 0 CCMMISSON NUMBER
a '2 m * CC7234G0
7i �+' Q . MY COMMISSION b(P RES
O F FA MAR. 29 2002
23 - /1'
Signature of Contractor or Owner - Builder Date
T/9'
Date Notary as to Contractor or Owner - Builder Date
My Commission Expires:
RADON C.C.F. r P ° NOTARY
BOND
TOTAL DUE . 5 1/ (
APPROVED:
Zoning
Building 9 Electrical
Mechanical Plumbing Engineering