950 NE 100 St (4)Date /40 Address
Legal Description
9 6 - D / 20 s '
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
/ Lessee / Tenant U " /
Owner's Address . /GU S Phone 7 -S_/ — 3 SG-
/ X06 S /6 2 «' sr
Contracting Co. /*/°77Z C�O<'/ ��%- Address /2?i/1/11/ LAW- Fe! 530/5
Qualifier AO FA/ ,/I�I.��TU ss# , q',24" 4/6
State #6 n20 Municipal # Competency # Ins. EecG 9 �s•
/ t3z7i chi, /7/4 •
Architect /Engineer i' 1 -� Address /1
Bonding Company A /`" Address l''t I A
Mortgagor Address N (
Permit Type(circle one): BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION LS <ce/Z 5 / J - ati /r5
Signat fowner and /or C. do President
Date:
6/h/f3
Notary as to Own d /d01114400y; (tAgtdent
My Commission E ptc es:STATE OF FLORIDA
Public My Comm EVE/27/95
BONDED
APPROVED:
Zoning
4 f- J)0 M/11 / f =S 1 e'
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 ve -name • contra or XXd do the work stated.
ss c6 7�/‘ •
Tax Folio // �� 3 7 D j g
Signature of Contractor or 0 ner- Builder-
Date: -
Master Permit #X. 0
h
Building Electrical M,
as to Contra tor or %Owner - Builder.
ission Expires:
** * * * * * * * * * * * * * **
FEES: PERMIT V
/,‘; RADON C.C.F. ) NOTARY TOTAL DUE f
Fire Other 1 ,
Mechanical Plumbing Engineering