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117 NE 102 St (12)PERMIT APPLICATION FOR MIAMI SHORES' VILLAGE D a t e O � 9 / J o b Address / / 7 / J Tax Folio Legal Description Historically Designated: Yes No ✓ a Owner/Lessee / Tenant 7 () Master Permit # `� 17 6 7 Owner's A d d r e s s // 7 A 7 - /,, 65F / 7 ) - ,5/40Es P h o n e 7 ' O Contractin Co. 0 \ti/ (t Address Qualifier SS# _ State # Municipal # Competency i :o. Architect/Engineer Addresses Bonding Company Address M o r t g a g o r /L' 7 �i CI- O 1 � Address Si e of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: My Commission Expires: F J L 76o 0 - 2-4.5 -58 c© — Permit Type (circle one): UII� ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION e...4/77‘ e /44 G4X '4 47H 4 / 'b / pA1/4.7' J ee) ,/ Square Ft. Estimated Cost ( value).t 460 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 construction and zoning. Furthermore, I authorize )he above -named contractor to do the work stated. or Qv er -13: der D e 6th Z/ -// Notary as to Contractor or Owner- Builder Date g/�//97 FEES: PERMIT y0. RADON C.C.F. to 0 NOTARY BOND TOTAL DUE 4 1' APPROVED: Zoning Building q f'( 1 ! Electrical Mechanical Plumbing Engineering