1201 NE 102 St (4)Date Job Address 4 0 (k/5 /6 ZS Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant Y/ Lnl,4 l!J C 14 L - vJi Master Permit # «y 7 g
Owner's A d d r e s s /4N 61 /IC / a 2 N e e Phone ) /.5 - 75
C o n t r a c t i n g C o irk . /11. ✓•! or4 e . d A /L ✓ Address
Qualifier C N, 1 %, SS# Phone jv7/ ° O .
State # /6 4/ 702-V Municipal # 3O /64/7021 y In
Competency # 0000 / 7 s. Co G/2?
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION O� /NT_ GCJ ! 6 — �7ili f �U �eJA`
Square Ft. Estimated Cost (value) / 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 be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do th work s
ture of owner and/or Condo President
otary as to Owner
My Conunission Exp
Con _3rr.._,.�LAR Date
COMMISSION NO. OF
CC/141103
MY COMMISSION EXP. MAR. L2007
FEES: PERMIT rO RADON
APPROVED:
Zoning Buil
Mechanical Plumbing
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
-20 -9f
Notary as to
My Commiss
TOL �o
3012 6
Electrical
NOTARY ) BOND
TOTAL DUE 7/0 Z O
Date
$ / - 6/ X97
Structural Engineer