171 NE 102 St (12)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date CO 111 19g Job Address i rl NE I c5. - i Tax Folio 1/ 39 - 67 3 /j
Lot`- z•- Z z
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Legal Description c, �.) l Gvi. / / i9 /�. l3 Historically Designated: Yes `� d No
Owner/Lessee / Tenant F � L., 0 .e `l -- Master Permit # 3 v v 9
Phone 9 5-tk et 30 0
Owner's Address
171 10 a ( z 2 ' 7 "
Contracting Co. f bT & e.0 Yi 4 -C1r iJ 1 ce,S
Qualifier NiC.Kt9kGS ,ccoktyt)
State # EF000 I U RS Municipal #
Signature of owner and/or Condo President
11
Notary :.3' ''; r : t�i:� i l�';0 6 . 4e 710 t
My Co ' ? = Zxptre &pIREs: May 19, 2001
• o ,-No Bonded Thni Notary Public Undenivdtera
FEES: PERMIT 7.1 / e ' v RADON
9b
Dae
Date
SS#
C.C.F. • 60 NOTARY
APPROVED:
Zoning Building Electrica
Mechanical
Address S • Pacer(i ne_
- Phone (09 - 7770 x 52e-
Competency #
Address
Address
1 ° `-e
Ins. Co.
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING LECT CAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION -(rQ V fir urN.
Square Ft. Estimated Cost (value) ''$ 1 5c 1.
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 re lating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
AREEN A. HUTC INSON
Y COMMIS ;� 48710
EXPO'
Uilde ry it'.
Signature of Contractor or Owner- Builder
Notary as to C • ==
My Commission Expires:
BOND
TOTAL DUE
Date
Date
/9, 4 - o 79
Plumbing Engineering