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640 NE 101 St (14)1 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date ti--/ L - 9 J o b Address 4-0 A)L / € 1 7 - 5 / - Tax Folio Legal Description L-o r a .3/ `{ 1 s r % o < s Historically Designated: Yes No t— Owner/Lessee / Tenant tO / s ti Q-a, •, G � & : rL , ' s Master Permit # 6 Owner's Address ' V t A.)<__ /0/ r it S f Phone 7 — 2. 6 6 Z- Contracting Co. { L 6 -'-, c>-,---0 �e•J -s z. /Ai Address 7e z 7 Go Xro„r),, -- --, /<L.,,/ /ay 1 I `L ?,iA ,,--c__ Qualifier 9 i✓O r5 e- -f • /v c' A-r -�-... SS# Phone 7sY - / 7V -- z Z 24 State # C-. 6-C Co 5757 Municipal # Competency # Ins. Co. Architect/Engineer /V 6 1.) e__ Address Bonding Company Mortgagor /.J a "'``-- Address AJ N Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE WORK DESCRIPTION 01 eavat -el S w / z� 51 SIGN r o [ r f . J -r..) / ( » K ' G Ci N G� �, S L.a - �a r.: j r 1-e p i. / fZ ¢J. / c".: / . r c / 41, / y' Square Ft. Estimated Cost ( v a l u e ) L u & c ) 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 w k will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -nam- • `•ntractor tondo the work stated. 1 Sis?nbture of own dr and/or Condo President s' Notary,'as to Owner and/or Condo President My Cmuniii0F577171ARY SEAL .0> i ROXANA C ALVAREZ 0 1j! 0 COMMISSION NUMBER u� ti !jpaq Q CC447999 4O MY COMMISSION EXP. F oF FA O ?5,199t1 kl/ ate tf‘;•-; D te FEES: PERMIT 2/0 e g4 RADON C.C.F. /4 NOTARY APPROVED: Zoning Building Mechanical Plumbing qvilfr /l Signa of Con ac . or Owner - Builder Date Nitary as to Contractor or Owner - Builder Date My Commission Expires: Electrical J` ( � OD BOND " TOTAL DUE " � d Engineering PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will tie made to certain real property, and in accordance with Chapter 713, Florida Statutes,. the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: 3 �' a - , - 4 d s f %L / p L. 0 - 7 S 6 e- UGC J o .3 vY-rn e— c 1 .47 6- -7 o' 4 / ' S 4 e , . t� L 7- • V :. eJ / y Pro Is 05 IY p i) c- 2. Description of improvement: 3. Owner(s) name and address: 6 4 6 /3 Interest in property: Name and address of fee simple titleholder: L0 /J f i /,U c. r s 7 4- C. T v L-r- ti CZ -, s ZV L /V 4. Contractor's name and address: /,u j 7 • 7 e 7 W 6 v / 5 L, al Pe - 7 el - 7 � r 4 337 5. Surety:(Payment bond required by owner from contractor, 0 any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owner designates the following person(s) to receive a copy of the L'ier,or's ITtice as, provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of•Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified Signs urs of Owner Print Owners Name Sworn to and subscribed before me this J- day of /V Q hckf 9 ! -!' Notary Public Print Notary's Name My Commission Expires: POV C- lC e� •Q iL 1 H / 4-1--2-/ / S ✓,. i I■U 1 sut UN COMMENCEMENT C �l r� 1-- . (Vu rid /t r�) ■i(.1 4,10 k C. J d Y �--.- I 0 / KATE OF FLOR :Jr, I X21\ Y Or © L /0 ' Chu 4,Qd n. 1 r C✓ii ::i my h-:ac c i O4% c! l Se las: olli -,... 968531101 1996 NOV 20 09:06 �-- 1 J 7,-. Aid L / 1- ) G c /C ,c Prepared by: C c -• -777-- -Addressi: ---- 0 ,, 4/ / ' /a/Ix v ) � p� Y r- & & O FFICIAL NOTA • i # /7y < i ROXANA C ALVAREZ r py/y ,,,., A3') y COMMISSION NUMBER , t '4 Q (;(:447000 - �� MY COMMISSION EXP OF F\P ' MAR. 25,1999 333 / 7 P! ./ 7'n r KA1�l��2iNE MAproN 6 NC_ ion sr • NI i F7MA S1/D2LS 3313 PiA plfiEr wa r' 4" Up l'od Psi f--- ealvc, rG sx44,6,- Fs' 690 NW 51 Street ° Miami, FL 33166 • (305) 551.8394