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301 NE 102 St (14)Legal Description Square Ft. My Commission Expires: APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE fa 7/ l 61f � // 3.26 (0 13 - I Date � Job Address' -- ax Folio SO L)f /3 4 /k 37 /7).S .mac . / igh/r)(1 . Owner / Lessee / Tenant Tar a rf fl'1 (.CJ c -\ Master Permit # r y �Y,7 Owner's Address , / /V - Mak-C?' - Phone 3o s . 7�/Q Contracting Co. Ou ) / 2_,r Address Qualifier SS# - - Phone State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Signature of owner and /or Condo President Date: Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION h S (1 2,0 o ©d 7 c k WO, r UO ,f c/ Estimated Cost(value) My Commission E ** * * * * * * * * * * * * 3, DOV 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. Notary as to Owner and /or Condo President Not' y ,s to Co tr ) i ; dn No.CC197545 PEES: PERMIT RADON C.C.F. ) NOTARY 5/ TOTAL DUE ** (-b6 Fire Zoning Building Mechanical Plumbing Engineering Other Electrical