REMODELINGDate 10 '8 ' 1 6 Job Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
loo sT•
Tax Folio
Legal Description Historically Designated: Yes � No
�n G�
/ Tenant r-I4u2— I fl CAS oG
) ►") f
Master Permit # `�/ o y g
Owner's Address "1.E. 100 ST M I G1 Vrl) S11O T � FL. 331 3P Phone 757 ' 0827
Contractin Co. j4 / ,- . 0 1 N f r L Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Nile . Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION GX► s ► t v1 L j room ►"G ✓►1 b Ahe, `1 r" 1 P---t O Li E T 3: LE__
P-e pIAcc. t )i_r
Square Ft. - ?
Estimated Cost (value) i.,-)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.
Signature of owner and/or Condo President Date
FEES: PERMIT ' . RADON
APPROVED:
Zoning
Mechanical
Building
e of ontr ctor or Owner- Builder
x2-7 )
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder
My Commission Expires: My Commistoir5xpi OFFICIAL NOTARY SEAL
o , < .- s Aw ®RA M bo rILL
0k COMMISSION NUMDEW
. T Q CC4012G1
- , •. - o (,° My COMMISSION .a t'.
4'6 CA-C two, I i
C.C.F. 0 NOTARY 6 - BOND
Electrical
TOTAL DUE
1015-96
Date
Date
10— 8 -9�
Plumbing Engineering
. Date
PERMIT ATbICATION FOR MIAMI SHORES VILLAGE •
Job Address 5. 100 ST; Tax Folio
.egal Description Historically Designated: Yes No
Owner/Lessee / Tenant lr• M y 1 0\ Master Permit #
Owner's Address M � 1 5r
Contracting Co. N/A ( u r) r) Address
Qualifier SS#
State # Municipal # Competency #
A r c h i t e c t / E n g i n e e r I . . 4r #0.z V S Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDIN ELECTRICAL
VY
WORK DESCRIPTION ) OGi ° u I G am-'
(E)1)1 C:1 + V
Square Ft. Estimated Cost (value)
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 c• . .: . .... = .rk stated.
Signature of owner and/or Condo Presider Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON
Building
PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
C.C.F.
Phone
Phone
Ins. Co.
d ons G VIGlo sec
Oa0 .00
/ S-c-e 6 -et-)D2 rt-L-4/
Date
p NOTARY SEAL
S NDRA M MONTIEL
* COMMISSION NUMBER
. 1' CC401261
9 r .,
�\ MY COMMISSION .EXP.
� OF F AUG. 17_
Electrical
3 8,2.0a_
or Owner- Builder Date
NOTARY 5 TOTAL DUE 4
Plumbing Engineering