410 NE 102 St (2)Date 5171 / 9�
Legal Description
6 %/1..essee / Tenant
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address co 107 4(1 St. Tax Folio
�C�' M; c Sl -co res Sec L ! PPj SC-1 Ll
11 i • : ! u r . Historically Designated: Yes / No )i
17 cki V Ov�
1 4/o N4102
l
SLdr2S
Address
Master Permit # / 1( 37
Phone
365_ 75 - H`1nn
Contracting Co.
Queer - Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION pG i ,,, , n 5 � _ S, P � o J ys \y 7 �.. j Moo r.e (-o -
�# 11-6 9 Cr/ \,. Q - -con `t'r I t
Square Ft.
101 Sc
Signature of owner and/or Condo President Date
Estimated Cost (value) , o!). 00
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 -named contractor to d• + e work s ted.
Sign ure of C
ctor or Owner - Builder
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder
My Commission Expires: My Commission Expires_
d +12, NOTAGIV fl�AL
: :,x1 CB • m:a.
FEES: PERMIT 1-7 RADON C.C.F. . ‘tf2 NOTARY - BOND
177117
Electrical
Date
5 2 ate
7/7
TOTAL DUE 4(f., 4.0
APPROVED:
Zoning Building
Mechanical Plumbing Engineering
BUILDING
ELECTRICAL
PLUMBING
Architect
Contractor
or Builder
Legal
Description
Address_ of
Building
Lot
MIAMI SHORES VILLAGE, FLORIDA
DATE 194_
PERMIT N° 4565
Work to be performed under this Permit
Owner of
Building
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the a pli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th the understanding that the work will be performed in compliance it any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be e oked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon. wh this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinanc s and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed • B
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
Bl.
Subdi-
vision
Value of
Project
Contractor's
License No
Aint. of
Permit
CONTRACTOR OR BUILDER BY AUTHORITY