501 NE 102 StDate 1- /q V Job Address 50/ NE /02 ST -`Tax Folio / /3246)c /`7o?
Legal Description H OU SE /` n n
Owner / Lessee / Tenant EC I.O 0o_ Icy 6. \i „,Da. 0).00.j Master Permit # 3774
Owner's Address 7 / A/ 0 ?- Phone 7 6 ' 7 4.7• d
Contracting Co. 4/41,(5 I!'Y Address 5 7e„r/1/1fr '0 kr
Qualifier 4 / /&14 SS# / Phone 5�1 -Aw s--
State #V 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 IN STA LL M Sy
ALA E
N -/
Square Ft. /l Sh Estimated Cost(value) / 6 �
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 an MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is acc ate and that all work will
be done in compliance with all applicable laws regulating constructio
authorize the abov - amed ontractor to do the work stated
ignature of o e *sod
Date: 11/4_ 4;
Notary as to MI CY 0421%1'%•• / off
�
My Commission Expires:
** * *
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
AP
10
;g A nffieent
J / 10 ROBLES
• • m fission Expires
F D ,/ e 4 1996
n$8• PFe
FEES: PERMIT 3e; ”' RADON C.C.F. ► NOTARY TOTAL DUE 3U•
Zoning
Mechanical
Fire Other
Building
Sign
Date:
Notary as to P iaaet' or Owner- Builder
My Commission Expire -:
* * *
Plumbing
and zoning. F '•th= re, I
4% ....:
Electric
— SEA1der
ROBLES
mission Expires
e 4, 1996
�-a
Engineering