920 NE 100 St (3)Owner's Address / ae
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address ,//4/ , Tax Folio // 3 C. J€
Legal Description gy
Owner / Lessee / Tenant 4.) • /
Contracting Co. M4/107 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 ROOFIG PAVING i�ENCE SIGN
WORK DESCRIPTION / / - f" De- //,7e-ere
71 6
Square Ft. Estimated Cost(value)
Go
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 cons• c '.• nd :n �Fuxthe � I
authorize the above -named contractor to do the work stated.,/ i e �r P- ` opp.
i_ J•nt
CIO„
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
APPROVED:
Zoning
Master Permit 1f 339//
Phone �- �(�
ature o
actor or, Owiter-•Builder
1:Fitary as to Contractor or 04110Y-FAVic'ider
r y Commission Expires:
State of Florida at Large
My Commission Expires:
November 1, 1993
* * * * * * * * * * * **
FEES: PERMIT .3 RADON C.C.F. ;' /Q. NOTARY TOTAL DUE 17(
Fire _ Other
0, 7 Buildi a F Electrical
Mechanical Plumbing Engineering