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750 NE 101 St (8)Date Legal Description / C Owner / Lessee Owner's Address 1 X J 1.1/4 Contracting Co. 0' , i � Square Ft. Y „1 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE / Job Address r ( �I ? Qualifier( !( C2 Y State #' Architect /Engineer • Tenant r 'l ; r x �� 4., 1 "l')61 Municipal # � Bonding Company Address Mortgagor Address Permit Type(circle one)( BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN WORK DESCRIPTION , 4o 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 pp be done in compl' nce'\with 11 applicabllaws regulating cons ion and z /ing. Furthermore, I au rize'Nt a ab±oo e- naiged 'ntraf� db for to' the work stated. i r,. X11 1 T Signature of Date: .y Notary as to Owner and /or Condo President My Commission Expires: ** * APPROVED: owner and /or Condo President NOTARY PC3LIC. STATE OF FLORIDA. RSY cor ;ISSION EXPIRES: SEPT. 26. 1994. *Et NuT/ tY YUOLIC L*IDERWRWERO. SS# Fire Zoning uildin Mechanical Plumbin Tax Folio 1 3 ( G ,- • t Address Competency # Ins .Co Address ., Estimated Cost(value) Signatu Date: Master Permit Phone . 1 - /1 l v' g.7-1 f Contractor or weer- Builder Notary as to Contractor or Owner-Builder My Commission Expires: NOTAR7 PU3L:C. Sa ATE O. F'_ORDA. MY COMMISSION EXPIRES: SEPT. 26. 1994. 113oNOL:D Tri.1 NDTA* 144FI14G *NPIRWR1*RS. FEES: PERMIT S Jr RADON C.C.F. / 61! NOTARY TOTAL DUE,/ (1, ** Other Electrical Engineering Unit No. Prdt Slid Door Win Entry Door Room Opening Size Width Height �% �..L :tion US Profile Color OIS Profil Color Fram Color ' ' � otor Mtr/Or Zk \ q 0 z - .; :C. 2 vii 3 , 4 5 -----" AIM % i1` ' X 17 ? f3 1 9 10 TOTAL AMOUNT / 06 tier) DEPO IT y, Min. Required) ` 36 BAL. DUE C.O.D. Pay Installer ,, �© Installatio e • ted to begin in approximately to weeks from date of receipt of deposit. T s is only afi estimated date and you will be contacted to schedule the actual installation date. CUSTOMER NAME BILLING ADDRESS '11 �( EPHONE Q HER PHONE We propose t f Special Instructions FLOOR OF BUILDING Is "high- work" required? as: Lot Block , Sub Division. ROL -4 ROLLADEN INCORPORATED nd e following: Tota openings o be covered (multiple count as one). Units are numbered from left to right fromt -- tftleidr^ •��( Filler Panel(s) to be located in secti.. and No and-0(p,� • NoneO --�� Shutter(s) to be installe Outside D ,� Rear Indicate by number counter clockwise XQ OMIT Front Electrical hook -up included in this price? X141 NO O7 .205mie901,9,4t ❑ Recessed ❑ TERMS OF PAYMENT: BALANCE OF PAYMENT IS DUE UPON INSTALLATION. In those cases where electrical hook -up is to be performed by Rolladen or its authorized sub - contractor, a maximum of ten percent (10 %) of the contract amount may be retained pending completion of same. OWNER OF PROPERY? ii IIIPt 1 (If NO, fill in Owner's name and address in space provided at top o orrn.) �/ Products are to be installed on the premises situated in °— County, State of Y — owned by Purchaser and described CONTRACT SUBJECT TO ADDITIONAL TERMS ON REVERSE SIDE "BUYERS RIGHT TO CANCEL" "This is a home solicitation sale, and if you do not want the goods or services, you may cancel this agreement by providing written notice to the seller in person, by telegram, or by mail. This notice must indicate that you do not want the goods or services and must be delivered or postmarked before midnight of the third business day after you sign this agreement. If you cancel this agreement, the seller may not keep all or part of any cash downpayment." EXECUTED IN SIX COPIES, ONE CO 'Y fr F BY BUYER, LL IS DAY S • F _ �/ '•� (Purch ign Here) Accepted & Approve e� O DE NO. MAIN OFFICE rolladen IDDRESS 'S /"[ PROPERTY OWNER 43 � 4(- LeatT Go 13t HICH WAS LIVERED TO, AND RECEIPT IS HEREBY ACKNOWLEDGED (X) (Purchaser Sign Here) Page _ t vr; Ct..ce> &)t.tT HE_R_LAN3Z P t or& ( tc-