361 NE 102 St (10)Date C d gl
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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3Co� � - (CD TaxFolio d c [ 2 J 569 b
Job Address
Legal Description 3c,, I NC_ 0
Owner/Lessee / Tenant C C CO n n e l) �✓1 S O r1
Owner's Address 3C,c1 N to') _S t c-uA
Contracting Co. S c-'"• (- -Z C1/4! C StrL ` -t' ` o
Qualifier Roved SDr�4-�EZ
State # C &G 05449 Municipal #
Architect/Engineer I c i S, l n c .
Address
ss# Phone
Bonding Company Address
Mortgagor S Be,k_ Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION DEL"- (. S h -` � r` � C�- `2R ll ru
1 a, h--
Square Ft. ,
Signature of o er d/or Condo President
Notary a Nner and/or Condo President
W t
My Co .�::� i . s Expi Llama st Llama
* * My Commission CC605842
ill fi,4 . Expires December 8, 2000
14 OF 0.
FEES: PERMIT '... RADON
APPROVED:
Zoning Building
Mechanical
Date
Dat
Historically Designated: Yes No
Master Permit # 1(/(/ I
- 757- 51-1-1.1 ' 36'(
Phone t 1
1 l Sw 1 L 4-h py„,e (y1 A
34=5 85 '747
Competency # Ins. Co.
Address 33c ( Cyr A l>J \ F
Estimated Cost (value) /0) 11116
coL.JL ITV
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 • will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -nam contracto t a • e work stat
C.C.F. � pi NOTARY , ` CO
er- Builder Date
o in 9W91
Notary as t ontiactor oY t'1'de ant»na�wewe t»� < Date
My Commion Expire P °e Mary <
Notary Public , State Doyen of Florida <
'3 ` Commission No. CC 639115 <
i lom.9 e C
My ommission Exp. 06/16/2001 <
1- 800-3- NOTARY - Fla. Notary Soviet 8 Roadim8 Co. ( <
W•1is,' 1Ysvt\lN�� NW.AMNNNSl%lllllll <
BOND - 30/ t6
TOTAL DUE 3/Psi/
�✓
Engineering
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