237 NE 102 St (9)Type Insp'n
Permit No.
Name
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Bui ing Inspection Request
Date 2Z Time
)11 Aairtkaki
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Address c23 q- N1 / Da 3
Compan 0,1.A t /\
56sU
Phone #
For Inspector:
Approved 1
Correction
Re- Insp'n Fee ❑
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 31 / 0 a Job Address 02 3 7 Ale / D Z 57L Tax Folio [ 1 71206, 013 1A S Q
Legal Description t 'Dr Historically Designated: Yes No •
Owner/Lessee / Tenant Du 1 4 N E M • Y0 1 p .r Master Permit # /7 (jj 4 t t)—
Owner's Address pl 37 Ai E / o Z s4- Phone 305-75./ - / b$/
Contracting Co. 14 1 Address 7 i 4 7 J1) cv li fS / A4 / I. rM I
Qualifier Ny C 6+ r n SS# S1 o- 26 - 3 hone li 3? 30 O, ski
State # T-1 ODD caq l i Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL UMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION �� e,.. cr It ,
7 ' +--� ✓�
Lon,? , / 1 ( Ivey( ( C
Square Ft. Estimated Cost (value) Pe D . 0 a
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.
/1-4P A► 4 t2-5 I ' 7 ' 3 5( 3 S L - _ o
r i '/ 3' wive) .: v -L
o O owner an. •
Si
ondo President
FEES: PERMIT re m e ° RADON
er- Builder
OFFICIAL NOTARY SEAL
MICHAEL ALAN CLARK
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC751622
MY COMMISSION EXP. NE 15,2002
Signature of Contractor or
otary as to Contr for or Owner - Builder
ty Commissio xpires:
C.C.F. • 1° NOTARY
Date
Date
TOTAL DUE
APPRO VED:
Zoning Building Electrical
Mechanical Plumbing Engineering