511 NE 101 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 9 JR Address •‘// N`=, / Q / a 7. Tax Folio j / — 4 i �� — 0 /7 /0,*
Legal Description a4 / ,r; /Aft y Historically Designated: Yes No K
Owner's Address 7 A/ 61 i 7 / $7 Phonl & ,0.1- 712' 57Nr7
Contracting Co. 0\61 NI E-73R Address
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one). BUH,DING ELECTRICAL PLUMBING MECHANI ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ,CA,( /hYCL;1-PL))
Square Ft. Estimated Cost (valu
if t
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.
%2 L � � / ) (47,
Signature of owner and/or Condo President Date S gnature of Contractor or Owner- Builder Date
s'3 17 y a -A/4. 2avD
Notary as to Owner and/or Condo President Date _ : as to C
My Commission Expires: My Commissi
FEES: PERMIT 1 l RADON
APPROVED:
Zoning
Mechanical
Building
b�
C.C.F. 3 ! NOTARY
e rica. 1 11
n xx ctddr*
NO rARI PUBLIC STATE OF FLORA
COMMISSION NO. CC7I4I0
MY COMMISSION EXP. 1
Electrical
BOND
TOTAL DUE q / f 6
Date
Plumbing Structural Engineer