520 NE 102 St (4)ERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date � ' •b Address . 520 c /c72-4 Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant
Owner's Address
Contracting Co. _
Qualifier 1/ '' c SS #
State # Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING
WORK DESCRIPTION z
otary as to 0
/or Condo President
My Co r nussi•'. •• : OTARYSEAL
GLADYS) VILLAR
NOTARY PUBLIC STATE OF 1.0RIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2002
FEES: PERMIT 0 RADON
APPROVED:
Zoning
Mechanical
r Condo 'resident Date
F•s 2 " 33 � V7
/ ,P////9
Date
Building / FV /
MY C
c )
Competency #
Address
Address
C.C.F. (J a NOTARY
Master Permit # 94-3 9i a,
7
Address - _ <=9) ' � ��$C . / / // .)A,
Phone
MECHANICAL ROOFING PAVING FENCE
Square Ft. Estimated Cost (value)
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 • . . ctor to do the work stated.
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r � C o ntractor or O /+er- Builder
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o
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ficRID
AI� O. CC714
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Electrical
Ins. Co.
SIGN
Date
1
o 0 - Builder Date
J �A ` -
�} S //l 01 oit-If
BOND
TOTAL DUE 4z
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Plumbing Engineering