1170 NE 102 St (3)Date
. r.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address
1170 N .E. 102 sk1(Qt Tax Folio
Legal Description Historically Designat : Yes No
Owner/Lessee / Tenant M Q Y it eor r ecz , Laura tRYUfes aster Permit # 1 /jd6 9
O wner's Address 1 1 7d E 102 Sire et
Contracting Co. 04 G P P! I T L Nf c, l N C,
Qualifier I) R U.J I N , Y10PLEN <) SS# - - _56aSPhone305 .151 • 13
State #4. Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
y �Permit Type (circle on :� : BUILDING ECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION. Pr; INTl n1 j EXTER u) (4(_If5 OF F,E:3tOEIJCE
p 1\I E Err. EooR, T Rl m, SofFi15,
Square Ft. stimated Cost (value) I 1 t /CO �°
WARNING TO OWNER: Y 9U 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.
OW1 R'S nAV1T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
cons oning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature oflpwner and/or Condo President Date
No
My 914.
mmission Expires:
BARBARA B. HUTTO
Notary PubDC - State of Horida
My ComrNsslon Expires Jon 24, 2001
Commission # CC 615626
ate
Address (aDS 0 YV.E Ot R V&
pires: } , GLADYS 1 VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
•
MY COMMISSION EXP.
fir :iv
� J A / ?uO »-'
No as to Contr
y Commission E
FEES: PERMIT ( RADON C.C.F. / • ' ° NOTARY
Sigurey'ptrpctor or 0
Ph (50S) - 757 7 / a.,
FT. LptuPERDALE Ft,. 'B302!)
v /2 /9 - 00
uil�le� 3 370 �--, _, I5te)
((�� % -40
BOND
Date
APPROVED: TOTAL DUE
Zoning Building f`, f j P) eX Electrical
Mechanical Plumbing Structural Engineer
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATE: ]:k(; , 1 2on 0
OWNER'S NAME: m 0 ritzc Correct PHONE: (305)757 •7092
ADDRESS: 1 17D N M 102 STREET Oos ?.74-(o• o(oq
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ***
ADDRESS OF SITE: I170 NE - tot STREET Dcede.
CONTRACTOR & LICENSE (if applicable) d 9 pa i nti r , I n L' ., Lic * 3cl(O6 1
COMPANY NAME: d q pa; Y1'ti fl i %1 C PHONE: ( ) -1S'7.1 S T7 or
* * * * * * * * * * * * * * * * * * * ** * * * * * * * ** 4 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *
must be listed and indicate the color to be a mtt e . - � g1 �
All Elements on the site mu P
VWalls E )(key 1 r l ui 2 33 3
4ascia 3.1�, 2331-
l' SMpr1 aauJ .1A1 • 29 3
Roof .` 1)1 S
Flower Bins
Shutters
Awnings
Chimney
ViDoors and door jams Corte) /So - mt p5 (cq‘ 11.W.2333
Garage Doors
Railings
Fences \ I \f‘
Decorative Metal
All brick (simulated or regular
Stucco Banding
Any other stucco features
Accessory Buildings
Other
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
const . ction and zoning. I authorize the above -named contractor, if applicable, to
do stated. Furthermore , the paint colors will be as per the attached
APPROVED:
Building Official
life
T
Luxuriant Gold A
6££ZMS
r
H
1M1 �ionj anlssaidwl
SW2334 -
Sign tur: of Owner Date Signature of Contractor Date
*********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
- le Lep/1 b r? / (3o0 -. 7&5 - - 2Zo"