514 NE 101 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
K Job Address .5—/ Ale_ / Gr 5 /
�y
Legal Description
Owner/Lessee / Tenant
Owner's Address C/2/
Contracting Co.
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDIN
WORK DESCRIPTION
Estimated Cost (value)
Square Ft. YOUR FAILURE TO DO SO FINANCING,
YND INTEND TO FAILURE FIN
OWNER: YOU MUST RECORD E NOTICE TO YOUR PROPERTY (IF NOTICE OF COMMENCEMENT.)
WARNING TO OWNE CE FOR IMPROVEMEN CORDING YOUR N
RESULT T YOUR POUR LENDER TWICE
OR AN ATTORNEY BEFORE RECORDING applicable). I
CONSULT WITH YOUR LEND
trove, and d this t the attached
I understand th a ble). I
' to do work and installation as indicated above, and on the attached addendum PP
permit t
Application is hereby made to obtain a P ING SIGNS, POOLS, ROOFING and MECHANICAL WORK•
that all work will be performed to meet the standards of all laws regulating con applicable
certify compliance with all apP
p uts are required for ELECTRICAL, PL
that all the foregoing information is accurate do that fordo will be the work s
OWNER'S AFFIDAVIT: cons n ti I an rt z o th Furthermore, I authorize the above-named
laws regulating construction and zoning•
adfie'.' / / ?- 4( Date
Date Signature of Contractor or Owner- Builder
er an or Condo President
Signatur
A4P `��rTw Date
tary as to Owner and/or Condo President Date '1,6 --
,0).0 PU OFFICIAL NOTARY SEAL
7
1, SANDRA M MONTIEL
* COMMISSION NJMDER
< CC401
y ' O MY COMMISSION EXP.
APPROVED:
Zoning
Mechanical
Municipal #
FEES: PERMIT RADON
SS#
Competency #
Address
Address _
Address
PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
ELECTRICAL ` ••
Building
Plumbing
Tax Folio
Historically Designated: Yes — �� q 7
Master Permit # 3
Phone s 9 _ /1/17‘
Phone
/
Address
NOTARY
Electrical
Ins. Co.
0
Notary as to Contractor or Owner- Builder
My Commission Expires:
Engineering
No
Date
TOTAL DUE
6°
•
•
Cilsgs4Gt. TA.volA,
, 4 c-d'
• t..1)T LINE
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Li]
n
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....;; STuti
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I2C)
Lot ONE
f\-05 RESIDENCE Folk
MR.. MKS. KOURY bENTON
L . Ei 35' of L. 5 BL%S 95 MIAMI 5/40
MIAMI SHORE
CO
CLEF
1;11:14