504 NE 101 St (3)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date (% /o / Job Address . ` 04/4.16 /?J/ i i Tax Folio
Lega l Description � O ‘3I pe<< 9 3- � G 1'1� Historically Designated: Yes No f
Owner/Lessee / Tenant /�/ CA/A eZ. F0/ 4;q fre Master Permit # 4' 9 153
Owner's Address ���� �� /O/ STi�G$T T Phone (€() 757 — 3 3 y St
Contracting co. .1,v ,e, STAiZ Co 2s7- Address ,0,3 b .S 1 , L 6 7 rr "l Cur
331
Qualifier 'P a �� s �� SS# $ - . Phone C 3 (r) 794
(3)323 - S33 r
State # Municipal # Competency # e 9D/ Ins. Co. Re-AZ .
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION STA ao.- v,eOEPE Jc >.a►y
Square Ft. _9
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.
Siarl albre of owner and/or Condo President Date
Notary
My Co
FEES: PERMIT
APPROVED:
�I
,: i ' on , '. ''': RODOLFO JUNCO
I -.i� MY COMMISSION # CC 852366
: >.- -�. o= EXPIRES: July 6, 2003
'if p °' ' ' Bonded Thru Notary Public Underwriters
RADON
Zoning 6 l e / 1
Mechanical
--o/
ate
Signature f Contractor
Notary as
My Co
C.C.F. 1 $ 0 NOTARY O ^ BOND
Estimated Cost (value) l`'cz 3 e
ntractor or Owner - Builder
ion Expire
RODOLFO JUNCO
MY COMMISSION # CC 852366
EXPIRES. July 6, 2003
of ;°.''' • Bonded Thru Notary Public Underwriters
Electrical
or Owner- Builder
6
Date
4-1-0/
Date
TOTAL DUE
Plumbing Structural Engineer
STATE OF FLORIDA)
COUNTY OF DADE)
The undersigned Affiant,���Pe\ 11 .Mi\ tsot.S, does hereby attest that the
(property owner)
attached survey, performed by X12 3 - -�.�.�
(name of surveyor's company)
performed on (, — , is an accurate representation of the existing conditions and
(date of survey)
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the
property without first providing a survey less than six (6) months old. The Affiant, as property owner, further
agrees to remove or obtain permits for any structures which now may exist on the property which are not
permitted or which may violate zoning or building code regulations. The Affiant further understands that the
existence of any such structures may affect final inspections as applicable to this or other permits..
Further, Affiant sayeth naught.
■
Wi gn and print) / Wit ss(sign and print)
SWORN TO AND SUBSCRIBED before me this day of f aJ� 'o
ant/Property owner
Affiant is cie known to produced as identification.
,1NY y' ;. RODOLFO JUNCO
* �!� MY COMMISSION # CC 852366
• rnni
± P EX Juiy 6, 00
Bonded ThruI PIRES: Notary Public U2nde3 rwriters