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390 NE 102 St (6)Legal Description /Yo' Architect /Engineer Bonding Company PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date8C J Job Address3 "7 /()E-/ 2 S Tax Folio l/ S46 /1 .57M / :3 c cifiS.Sie// Owner / Lessee / Tenant NA v U /7// 4 N / ©P�tW Master Permit # 3 ( W Owner's Address ,g / Q /L/1E /0; (5772L2-17- Phone 7 Contracting Co. e�� -/ s Address `SA Qualifier /07 A- SS# - - Phone State 1! Municipal Y 4'! Competency # Ins.Co. N X) i /4 Address Address Mortgagor f/4' A 14 ' (S ▪ C-1 P °12-7-(26 Address (emu ( ' Permit Type(circle one): BUILDING ELECTRICAL PLUMBING , M p ECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRI PT ION PA/ /u7 /UG- - e9V Kf SE Square Ft. :ost(value)/ /6 WARNING TO OWNER: YOU MUST .., ICE 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 compl'anc= with all applicable laws regulating construction and zoning. Furthermore, I authori. - med contractor to do the work stated. caner N nary s to Owne ;r� f� Signature Date: b is My Commission - Exp ** * * * * * * FEES: PERMIT ‘ RADON C.C.F, 7 APPROVED: Zoning * * * * * * * * * ** Mechanical Plumbing Signature of Contractor or Owner- Builder Date: NOTARY - r 0 Notary as to Contractor or Owner- Builder My Commission Expires: TOTAL DUE f_/ ct9 Electrical Engineering