561 NE 101 St (8)Date 91 Job Address 5.' ‘/ / °/ sT Tax Folio /, .ggeo / / / / /gif
Legal Description/ '/' W / 9 Ar'cv
er / Lessee / Tenant JlQ/(l� 6, /Q 441,4
Owner's Address 5- 4- 1 7 9/i /A/ $T
WORK DESCRIPTION
. 9/AS (U,%
Signature
Date:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
er and /or Condo President
i!ttary as to Owner and /or Condo President
ley Commission Expires:
*
A\ ,1„4-.41--
*
Notary Public
State of Florida at Larg^
My Comr lsslon Expires:
* Augus26, s `?9a
ss# .
Phone � v tef 8112
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 constructi. and zoning. Furthermore, I
authorize t abo -named contractor to do the work stated.
Sign of Contractor or Owner-Builder
Dat
Notary as to Contractor or Owner- Builder
otary Public
My Commission Expires: State of Florida at Large
My Ccmm:ssion Expires:
ar,
1 195
* * • * * **
FEES: PERMIT 'o 1 RADON C.C.F. NOTARY TOTAL DUE bl e %6
APPROVED: Fire Other
Zoning Building Electrical /
Mechanical lA Z Plumbing Engineering
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