133 NE 102 St (3)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7 3C. C 7 Job Address 33 1/7 / Uri- S T Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant lie P t - / 2, pp Master Permit #
Owner's Address /33 { tr / Og- T
Contracting Co. `! C2.3"-./ Address
Qualifier SS#
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one) BUILDIN LECTRICAL PLUMBING MECHANICAL ROO
WORK DESCRIPTION 0 -4 i l $2, (L-(I ,1 1129
Square Ft. Estimated Cost (value) /SOn, `'
Signature of owner and/or Condo President
9 /j
FEES: PERMIT / ?S D RADON
Date Signa
C.C.F.
Address
Phone 30S - - - Y- f93 C_
Phone
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.
i
e of Co ; tor or • er- Builder
Notary as to Owner and/or Condo President Date Notary as to A t ontract&l
My Commission Expires: My Con= "` • ue ��. A OF FLORIDA
A CM / MISSION NO. CC714103
My COMMISSION EXP. MAR 1 1
7
NOTARY BOND
�y/ 20
TOTAL DUE /e6 ( O
, FENCE SIGN
Date
Date
APPROVED:
Zoning Buil
Mechanical Plumbing Structural Engineer
Electrical