29 NE 102 St (18)Date /
Legal Description
Notary as to 0
My Commission Expires*, IF'
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address �2� /!/>� '.. Tax Folio
v, ij
Qualifier 42,14 I
State# 2 4a°`''
„'o , rem •e
Cent
FEES: PERMIT / RADON
ct s
Dat
1AL SEAL
LIO RO9LES
1141`66140 EXPires
Mune
m. No. _ + 6953
TS
Historically Designated: Yes
,/----_,, �`�-� // 4 Master Permit # 3,'40.3
Owner/Lessee /Tenant ' -✓ �✓' �.�i� /LF.� -� / /'°-
Owner's Address ,9-9 ,#,,/ /l ? 53/3Y P Phone
Contracting Co.
Municipal # Competency #
Address
Address
SS# - - ‹ Phone ..5
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING E 0 • L PLU : ING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost (value)���f
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 die 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.
C.C.F. ° NOTARY
Building
11 L d
Notary dt.:Pl
q ' c
My ComrilisAis ns
Ins. Co.
aauBpitd 6
. No. CC 205953
No
Address 5 7cr/v✓ / 5
TOTAL DUE
APPROVED:
Zoning
Mechanical Plumbing Engineering
Eleztri.al N1 C� 11�1