426 NE 102 St (6)Date
Legal Description
Owner / Lessee
Owner's Address
Contracting Co.
Qualifier
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Job Address 9 AIL" /02 -r% Tax Polio /I 11.0)
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Tenant ' <, , l / Master Permit 4t f '
?2 4; N45 %p2 . r — Phone
60,- iu tr - s'
Phone
State 4r` Yd4 Municipal # i/0/ Competency I''y
Architect /Engineer 7-,, ✓.:c 4 d' Address 6c// ii
Bonding Company /1. Address
Mortgagor ' Address
Permit Type(circle one :UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION
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 above-named contractor to do the work stated.
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Signature of owner and/ Condo President
Date:
Notary as t6wner and /or Condo President
My Commission Ex ires:
Y P 4 ik,,; "DAVID A. L£VINE
e.; 'h ::s MY COMMISSION:N.CC260247 EXPIRES
I d= February 17 1997. •
** * ‘ * * * 1,4 '' * BONDED NRUTRDV,FA1r eiSUHANCE,
FEES: PERMIT eU d RADON C.C.F.
Estimated Cost(value)
Fire
Zoning Building ) 4 1 3
Mechanical Plumbing
e
Signature of Contractor or Owner- Builder
Date: i- e`er 93
Notary as to ' ontractor or Owner- Builder
My Commission Ex;, " : '
:.= ) S N 7, EXPIRES
. Febiira ry 17
s
: rat „ � �••` '91DN�1! �N13RDhfAIN INC.
* *. ' * * • * **
NOTARY a• . TOTAL DUE O I/6°
Other
Electrical
Engineering
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