317 NE 102 St (11)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
D a t e ?""a•-• Job Address _ ax Folio //- 3209- - 013
1 5w W/%: Laf w
Legal Description �/ i S1 I .1 . Histo tally Designated: Yes No
Owner / Tenant a' (0,n X Z Master Permit # l ] R a3
3) APE: /02
Owner's Address
Contracting Co. ) \.A/A / E
Qualifier SS# Phone
State # Municipal # Competent
Architect/Engineer Address _
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / Q) L3? ar A' //NW''
Square Ft. Estimated Cost (value) Ad OY'" - / 1 cj Z 1
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 ctractor to do the wor stated.
/1
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Signs and/or Condo ent Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT 4-1 RADON
Address
Phone
igna
actor or
1)
Notary as to Contractor or Owner- Builder
My Commission Expires: - ;,--, u
C.C.F. c) NOTARY ,C -
wner -Build
1�..,, ....,,..JCS .._..
Date
Date
8 -z2 -97
BOND
TOTAL DUE IVY' 6d
APPROVED:
•Vt,
Zoning Bui1s , _ Electrical
Mechanical Plumbing Engineering