561 NE 101 St (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1 Job Address SAD / 6 i -O 1 ( . Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant jR of fi y 1)6
Owner's Address S 5u 1 N l ,01 1.
Contracting Co. C 4 1LD) v A (. Q IJ 6-6 ±
Qualifier �fL }4 J h f Cr�J fI S SS# ? Phone 73 (Pig
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING SIGN
WORK DESCRIPTION CN A��t LWK. L- T UM►MNn'! Pick -r cjCJ
Square Ft. 1 0
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 re: ating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
1
4.
.of own
stoO �e
p E
Signatur
Notary
My Co
r and/or Condo President
and/or ondo President
ires:
APPROVED:
Zoning Building
Mechanical
3h19-?
Date
c ?
Date
C0
4,(V „ Q
Estimated Cost (value) 7 2 , 6 A jujs -/ ge
JOEL BRODER
My Comm Exp. 2121100
Bonded By Service Ins
No. CC534717
[ j Pcrsopily Kaown t j Otbe 1. D.
FEES: PE W9.. RADON C.C.F. l -
, )sr - 1 77
Plumbing
Electrical
`
Master Permit #
Phone
Address GO 1N l' () 1 tr.
3 -'T•9T
Date
X117' 197
Date
o �dntractor or Owner - Builder,
ssion Expires:
JOEL BRODER
My Comm Exp. 2121100
Bonded By Service Ins
No. CC5347117
l 1 Yew "alts Kea rm B e 1. D.
TOTAL DUE
Engineering
03/07/1997 17:45 3053619955
CORALHGABRS,I CLLE33113Ir4404 THOMAS J. KELLY, INC.
OAO[i (1051444 -Teti LAND SURVEYOR
1111W13 (SOU) YTS- It0e
PAX : (105) 441 -0494
•
Sjs„E T C H_ OF SI
SCALE :i" '
HYDE ASSOCIATES INC PAGE 02
SURVEY NO.13'Zi?'e
SHEET OF