950 NE 100 St (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date // / r Job Address Tax Folio
Legal Descri tion
,7o (.v
Owner/Lessee / Tenant �
Owner's Address Q.5/ P/' /1. T O /i.1/' /D o77V
WORK DESCRIP'T'ION P/9/./07
Historically Designated: Yes
Phone 751 3?ti ?
Contracting Co. /TO Bt AT / t/ eM,s/9 r Address / O / 12. 5 fS C C.../9A/4 /
Qualifier /9L(11/4- SS# - - OPhone 57:3- ` V 9r
State # Municipal # / WC F Competency # Ins. Co. DR /T5 .
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
/c' /TC/'E, / 60/14 Aii/TF)
Square Ft. Estimated Cost (value) /2(2(/
Master Permit # /X
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating constructiopind zoning. Furthermore, I authorize the above -named contractor to do the work stated.
zT adao a Notary as to Owner and/or Condo Pr Date
My Commissi _ Expiress
\OZY P4/6 OFFICIAL NOTARY SEAL
O - n _ f,- BARBARA ANN FUGAZZI
z. ) * COMMISSION NUMBER
� c CC360191
F q. MY COMMISSION EXP. j
OF I'k jF3 29,1rnn
FEES: PERMIT
4/136/517 4;t �j (a
er and/or Condo President Date Signature of Contractor or Owner - Builder
RADON C.C.F. NOTARY
Notary as to Contractor or Owner - Builder
My Commission Expires:
.`PAY P4/ OFFICIAL NOTARY SEAL
0, �tl ,. --e� B ANN FUGAZZI
k, y » COMMISSION NUMBER
Cr) Q CC360191
i s MY COMMISSION EXP.
OF Fl°
BOND
TOTAL DUE
"Oa' ?7
Date
/J �1�7
Date
9,19 _ .
APPROVED:
b 1 6 /
Zoning Building G f � Electrical
Mechanical Plumbing Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date g" l7 . ? J Job Address R5 0 ME E / CC __S / - Tax Folio
Legal Description (A / ' , ' £ (( Historically Designated: Yes . .No
P ,4'7LiP Owner/Lessee / Tenant Z7 Master Permit # ( 77
Owner's Address fSo / " /60 67 Phone 2S/ — c 3 4 < `
Contracting Co. 0.3E /et (17/ Address /J gic5e c 0,1W/W--
4'
Qualifier r/ / ✓r' " SS# � - � Phone 8 9'43
er
State #
Municipal #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / 0 /k ( /yo / '9//yr •ExT i /Q / U/L
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 constructii and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
/ gnature of owner d/or Condo President Date
Notary as to Owner and/or Condo President Date
>My Commission . g _ / 2 —%7
APPROVED:
Zoning
Mechanical
FEES: PERMIT 6 ( 6 - 7 ' RADON
Building
Plumbing
l �D C Competency # /VU (, Ins. Co. /0
eat 04(
Signature of Contractor or Owner- Builder Date
AU 2c ad
Notary as to Contractor or Owner- Builder 1 Date
My Commission Expires: _ , c:-I c " '' 1 � p /a - 27
2 v NOTARY %--) BOND
C.C.F.
2D
TOTAL DUE. ( 7 / 6•
) 'h7
Electrical
Engineering