289 NE 102 St (12)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1 Z 8 7 Job Address;}-r '` (a y S'( Tax Folio Of — O 6 / ?>C-( — 9 70 /
L D L. V Z S 45/ 1 3(0 P13 /0 -70 Historically Designated: Yes No X
Owner/Lessee / Tenant A • )A\.1 1 i) 7) < S O Master Permit # L i Z 07 _ 4 _
Owner's Address / 09 Phone 2S — G / 74f 7 --( 8U
Contracting Co. j} Lo J /1 Q�` ' , 7 1 t ( (1 1 Address
Qualifier SS# Phone
State # 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 f0A4..,r
Square Ft. Estimated Cost (value) 3 % az.r0
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
Notary as to Owner and/or Condo President Date Notary
My Commission Expires: My
FEES: PERMIT ?� , RADON
rc�
Signature of Contractor or Owner- Builder
C.C.F. - AV NOTARY
9,ia9A339S9f.•Ag - T YI1iW mr»>
Expiredd onne Simpson
Notary Public, State of Florida
o Commission No. CC 416266
v ' FOF so e My Commission Expires 12/06/98
1- 800 -3- NOTARY - Fla. Notary Service & Bonding Co. ,,
/0/2,9( /1
Date
BOND
TOTAL DUE 4l-
APPROVED:
Zoning Building � I / ! 1 Electrical
Mechanical Plumbing Engineering
BUILDING
ELECTRICAL
PLUMBING
Inspector's Report: -
1
•
•
•
•
WORK
DONE BY
The following is ready for Inspection:
REQUESTED WILL BE READY
6 vi :: . E'' ,
. :: 7/ 71 1 .
JOB:
BUILDING
ELECTRICAL
PLUti1BING
•
•
•
•
•
The following is ready for Inspection: -
•
Inspector's Report: -
•
•
WORK
• • DONE BY
•
: - 7
AD: Cd
•
• REQUESTED
✓ o
• • •
t i G r ,ti t
•
a
f
WILL BE READY
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