318 NE 102 St (7)- PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1 -31 - 5 Job Address. \ 13 Tax Folio l \ a 0 Cc , t -'
Legal Description -- ''//
Owner / Lessee / Tenant AtA42C — A642ii 'A 10#j7Zj,jster Permit #
Owner's Address 3/g ,Ur, /DZ ,SS: Phone 31 476* 75
Contracting Co. � Address 5/ G!� „ S/10�F.j f /�
L77v , PL . 33� 8
Qualifier . t,rc,_ 37 /41 SS4i 9,S3° --ere) --?/-
State # CA. # Competency # -- Ins .Co . 4/6. oer5
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBIN MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION Lf p //a j Z v
C
Square Ft. Estimated Cost(value)
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 andzo ng. Furthermore, I
authorize the above -named contractor to do the work stated.
gnature of owner and /or Con4O Et*
Date:
Signatur
Date:
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4 .
_o : ' #CC 822965 Q�
Notary as to Owner and /or Con <�pt: o Q
My Commission Expires: ' �8` . ...1 0\;\ �`�� \
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FEES: PERMI
APPROVED:
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#CC 022965 =
Notary ag'to Contract F i W . e �u er
My Commission Expires: ��i ' �\
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NOTARY TOTAL DUE
Fire Other
Zoning Building Electrical
Mechanical 6 X61- Plumbing Engineering