344 NE 102 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date f ((1'4 I/ 7 Job Address 3 4 4 N F (0 S• Tax Folio
4; ,Q 9. (.Q_ PA " Q`l 11
Owner/Lessee / Tenant Nf R (/' A � + ✓A "� Qir fLJ` / �o�'"' t" Master Permit # 2 y
Owners Address 3 �F'f N E f o S' f: ( 1 , �'ti ` :A:74. 3 O ^ `7 S 7 3 2 Contracting Co. O� a' O f' r 2 s G
r
Qualifier SS# - Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Addre _
Addre;... -rQiM
Mortgagor
Legal Description
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION PY - wk. ' Q'`'`l `I 4 S12_
pe-\ p As ex 4 t)
Square Ft. 2 - r L 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 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
My Commission Expires:
FEES: PERMIT v7 • RADON
APPROVED:
Zoning Building
Mechanical Plumbing
e fr71 Q Historically Designated: Yes No X.
Signature of Contractor or Owner - Builder Date
Notary as to Contractor or Owner - Builder Date
My Commission E • ires:
0 • • U6 �. p SANDRA (NOTARY MNT1E1
w • * cOMMISSION NUMBER
CC401261
- c p MT COMMISSION .EXP.
OF OP AUG, 17 •9$
C.C.F. NOTARY 6 - BOND
Electrical
TOTAL DUE
Gj s ,6
Engineering