268 NE 102 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Square Ft. Estimated Cost (value) j*lJf-4f)
arc M o LtAyv torn 5
FEES: PERMIT RADON C.C.F. NOTARY BOND
D a t e a 3 o : J o b A d d r e s s c It Z e Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee /Tenant Master Permit # Z & L
Owner's Address Phone 3 7-c - 9
Contracting Co. f �, t 11J�P �Q _ Address
Qualifier SS# Phone
State # Municipal # Ins. Co.
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION L A✓ c, w>'+s L , 1 C,R-4cr—S �"tl ►
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.
Signature of owner and/or Condo President Date Signature of on -' : er- Builder ` ' Date
7 c j /.3/6D
Notary as to Owner and/or Condo President Date Notary as to Con W r or Owner Rnilr1Pr
My Commission Expires: My Commissim Fclqitbiktd, OFRCIAL NOTARY SEAL
mounek
` f%. DEC. 17,2002
C-o
Date
APPROVED: TOTAL DUE
Zoning Buildin� �e ' 1 , Electrical
Mechanical Plumbing Structural Engineer
BUILDING
ELECTRICAL
PLUMBING
- ROOFING -
Owner of
Building 1.J
MIAMI SHORES VILLAGE. FLORIDA
p v
DATE /� 195_x"
N? 2865 Contractor s
License No
PERMIT
- - - - - - -- -- - --
Architect
Contractor
or Builder 1 ' 3 ' '• - E (-\ 2 A — a 10
Legal Lot
Description Bl
Address of
Building
CONTRACTOR OR BUILDER
Work to be performed under this Permit
Subdi-
vision
Value of so
Project $ 'Zoo —
Amount of
Permit $
/, 7:,
This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or spe•'4ications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed { ' - .. BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work co -red hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY