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38 NE 102 St (6)Signal PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date OO -t3- l3 Job Address 38 NE 10Z "ID ST Tax Folio // " Y IP - NY-HP Legal Description Lo % 7 7a g tOGk- // 1- Historically Designated: Yes No • Owner/Lessee / Tenant 51 1 E (fit ('t tf\ i Master Permit # Owner's Address 38 - \ t 2 N S7 • 1 Phone ( - 758- 2 1 I Contracting Co. Ao S 7;94 S'e Address /d• G(/. 79 ,4 Ve S Qualifier Martin R. Anders n Slit Phone 0013 S -7PY5/ State # e 00001'O�4 Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICA , PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ti: P 1 pee M vs rAt L 44(Ms rE/Z / S - • EBRA K. TUCKE y�/(Mg l `• S ` p resident ssloll iipwt4>:U ATLANTIC BONDING CO., INC. FEES: PERMIT ! ©d RADON Square Ft. Estimated Cost (value) 1 dl s. oo 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). 1 certify that all work will be performed to Inset the standards of all laws regulating construction in this jurisdiction. I understand that separate permits arc 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 regula f g construe ' • I and zoning. Furtherm re, I uthorize the above -named contractor to do the work stated. of owner and /or Con •o resident D tc Date Signature of Contractor or Ow er- Builder Date yr OF A. misggili 2001 U ATLANTIC BONDING CO., INC. C.C.F. ' 60 NOTARY TOTAL DUE J,, APPROVED: Zoning Building Electrica Mechanical Plumbing Engineering