133 NE 102 St (8)Date
Legal Descrip 'on Lc57 / 9 % zoia Ref
Owner/Lessee / Tenant AA/N/9- /' /dv (.4'L S - Master Permit #
Owner's Address /33 A/c.-7
Contracting Co. (,) 'c ? I Cow/ S�
Qualifier a /91 V// V. P�
State # e .5 � 3, Municipal #
Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION � � �� /2// 7 ./ .L Al 0 /L 9 Q / N6/O
Square Ft Estimated Cost (value) 1 — 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 contra •r to do the work stated.
/
%.� i 11 a441 /.4
Signature of owner an or Condo President Date
FEES: PERMIT
Sob Address /Ye OA 5/ Tax Folio
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
es /ate
Notary as to Owner and/or Condo President ate
My Commission Expires:
O FICIAL N• ARY SEA
VERNE CHARLES- PIERRE
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC258650
MY COMMISSION EXP. AN. 221997
RADON
Historically Designated: Yes No
C.C.F. 1 NOTARY
APPROVED:
Zoning Building
Mechanical Plumbing
Phone
Address -502-83 6Q4.n// 57 17 /ya)00Ce
25-9 -2.760
SS# Phone
Signature of Contractor or Owner- Builder
Electrical
09/ a4 / 9
Date
at_h' ,e,..___oyei.4
Notary as to Contractor or Owner- Builder Date
My Conunission Expires:
OFFICIAL NOTARY SEAL
VERNE CHARLES - PIERRE
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC258650
MY COMMISSION EXP. JAN. 22,1997
TOTAL DUE 1 M
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