268 NE 102 St (9)PERMIT APPLICATION / FOR MIAMI SHORES VILLAGE
LLAG -
Date 1 1`7 rJob Address pQ D� Ale 16633i— Tax Folio I/ / F 3 v /
Legal Description ( I O t S (C Y)5 Miami Hi torically Designated: Yes No X
Owner/Lessee / Tenant &)Q -1 ba l
Owner's Address (_OS
Contracting Co.
10(9\ Srier
Address
Qali>ier 'PO in) .3 .Care
State # (ICJ Y) `/ Municipal # Competency #
Address
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING LECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
i S(ripm /2/
(*ices
6))9.6
. I 6
WORK DESCRIPTION
Square Ft. Estimated Cost (value)
d.
gnature o owner and/or Condo President
SHERRY L McINNES
NOTARY PUBLIC - STATE OF FLORIDA
My Commission Expires July 28, 2000
Comm. No. CC 572626
•
.�• that
ro amed co
ature of Contrac
SHERRY L. McINNES
NOTARY PUBLIC - STATE OF FLORIDA
My Commission Expires July 28, 2000
Comm. No. CC 572626
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 i s acc
laws regulating construction and zoning. Furthermore, I authorize the a
gula
Date
Date
— ate ._
Notary as to Own P•r Condo Pre
My Commission E
FEES: PERMIT 3.j RADON
Master Permit # I N
Phone "" I y
IOSa 31vvr' (i >
SS #i - Phone 09?/
C.C.F. r (g 0 NOTARY
s. Co.
work will be do .• compliance with all applicable
actor to do the work stated.
S' a Owner-Builder
Notary . _ ay c . - • r Owner -Bm
My Co
BOND
dm
6,-;19
Date
67 0
TOTAL DUE .3-5
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
1