375 NE 102 St (6)Job�Address 375 I3 O� S- Tax Polioi) �0 A� �/ o®
Legal Descriptionv 7 4-1 g3 4$
Lessee / Tenant ano 4\ en) Master Permit 1fr k.We
Date 10
Owner
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Contracting Co. d-I OT76n S'✓ curt
Qualifier s SonchD
State #0(Y)053a Municipal #
Architect /Engineer
Bonding Company
Mortgagor
Signature of owne and /or Condo Pre
Date: n/%.? 2,3
7 5 , E ■ O a kn ee
Notary as to Owner and /or Condo
My Commission Expires:
LOIS ELOISE LINDLEY
Notary_ Public. , tats Li Florida
** m Conxlt *s!or3 e.:; *; Doc. 15, 1990 *
Ceir.liil No. 1646263
PEES: PERMIT RADON
APPROVED:
President
Phone ' 7 5 8 ' - s 7 �`
Address SOO NE `I 3�7 S +.
SS# ( Phone -365 W 3
ident
Competency # Ins.Co. Ac
Address
Address
Notary as
My Commissi
NOTARY •PUBLIC,' STATE OF FLORIDA.
MY COMMISSION EXPIRES: Dec. 18, 1995.
BONDED THRU NOTARY PUBLIC UNDER
* * * *
Address
Permit Type(circle one): UILDIN ELECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 44..i t /" r 1 /A6r) trials -er �' T c//re r
Square Ft. Estimated Cost(value) Sv
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 -na d contractor to do the work stated.
g e
C ANNA ESQUIVEL-GONZAifl
••_ MY COMMISSION # CC 169117
` EXPIRES: December 18, 1995
i �;b?•` Bonded tint Notary Public Uoderwrltere
Signature of
Dyte:
*
C.C.F.
Fire Other
Zoning Building Electrical M
Mechanical Plumbing_
Owner- Builder
0 NOTARY TOTAL DUE ' '
dik
**
Engineering