400 NE 102 StDate 61(0 R7
Legal Description
Owner" Lessee / Tenant Q 't'7 - - 7
Owners Address �� * J ° E ° ' 0 T
Contracting Co.
eAdoMIlw
Signatur-� o Y,
Date:
APPROVED:
Notary as to Owl
My Commission E
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address
FEES: PERMIT 3,- . RADON
Zoning
Mechanical
/—
Sao 7�. �' ;
Folio // 3 6 • OP2 e )(4: 0
Master Permit # IS I
Phone (S /-�°
7s
r
0 ' � I Address
/ SS;�o _— Phone
Qualifier
State
Architect /Engineer .Address
Bonding Company
Municipal :r
Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL 'LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ■• -P A'.e �!
., .(5 lD — Ze4AJA -�
r a;4' /or Condo President
Competency 4
e P ta4 r0FOgtidoN�lpiitf kfLAP t
,,T1; SAMNA M HIRSCH
1. * COMMISSION NUMBER
Q CC348646
Q MY COMMISSION EXP
** * * OFF t �1A49. 1 /1 998
C.C.P. '
A4frgeL:t_
Signa
Date:
1
Notary as t
My Commissi
Ins . Co . eD
Square Ft. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
3O MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN F INANCING, 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 zoni• Furthermore, I
authorize the above -named co;, ctor to do the work stated.
f4 ∎ ., / 6:Ls ■
ure of Contractor or Owner- Builder
* *
o :.- 0
� OfncIAL NOTARY SEAL
r[) x i .
✓ . � rt za�.s SA+RIfdA M FIIRSCH
c if * CtiMMIE5ION NUMBER
Q CC348646
' OF F10 W COMMISSION EX*
_._ MAR. 1 1 !98
NOTARY TOTAL DUE
uilder
* *
Fire Other
Building Electrical(`/ % / �`�5✓L'
Plumbing Engineering