1170 NE 102 St (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
11 N� 102 Sr
Tax Folio
Legal Description Historically Designated: Yes No
/Tenant p Latk9(2A. ftiZiktcSi
Owner's Address 111 I J Lam) l O2
Contracting Co. ,'r 2 E 4r J Z/ LLB Z C G •
Qualifier .,105:;2G qn/,l 7.468 Z SS#
Address
Master Permit #
State # C U - C e' 'q c /6 Municipal # Competency # Ins. Co.
Architect/Engineer \/0$&" " " 0,u Z 2 Address ¢l ' /'.7 / ( 4- ?2!7 . /Q//4 4e1 re -
3i6i
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION (r) C N1e2L/7iO Al 2-1u/ /prep-rat Mil - r°7 7 &.) &4'r Pao 14
f) 074.60 . IZ! - 7 ■ 1 C.,1 /Ne - / p /1-0/Ai IJD', S
Square Ft. 7 /62re 5-f Estimated Cost (value) l/' /e900 o
Signature of owner and/or Condo President
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
0
RADON
Date Signature of Contrac
C.C.F.
Notary as to
My Commis
Fec
- 3oS
NOTARY
Phone %fr g � 340 2 (q -4 t° s'8 1s
4(S
/\/e / / 4 111-
Phone 3,5r e' ( 30 3g
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 the above -named contractor to do the work stated.
BOND
APPROVED:
�
Zoning Building � ) Electrical
Mechanical Plumbing Structural Engineer
TOTAL DUE
Date