514 NE 101 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address VS/ n E /0 6-L Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / TenantX.Te.a r\ S e -F c.- c., Master Permit #
Owner's Address 51 Lt 101 St. 1M t awe► S N oa.e s +- / Phone 305 73(7 14-1(16
Contracting Co. 0 \A) u" Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company
Mortgagor Address
FEES: PERMIT
Address
Permit Type (circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION € -Le o k
e x-Ec r t o r it) )i P.
Square Ft. Estimated Cost (value))( / D 0 . Do
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.
Signature of owner and/or Condo President Date
/ .1 -3 -f9
Contractor or Owner - Builder , Date
q .
0 444
of
Notary as to Owner and/or Condo President Date Notary as to Contractor OwnetlNOTARYSEAL date
My Commission Expires: My Commission Expires GLADYS J VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2002
RADON C.C.F. NOTARY BOND
APPROVED: TOTAL DUE
Zoning Building kt4C-1/171411 Electrical
Mechanical Plumbing Structural Engineer