53 NE 102 St (2)Date
Legal
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 1 1 , s I i Tax Folio
ption Historically Designated: Yes No x
LAO
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Contracting Co. f $ In1 N r
Owner/Lessee / Tenant
Owner's Address
Qualifier
State # Municipal #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION A (I� t lv C Th E &JJ i7 IL/ kS , (N C c. t D f III Y r f{SC
�TER
Square t. Estimated Cost (value) q 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 do the work stated.
Signature of owner and/or Condo President Date
Address
SS# Phone
Maize TWT
- Pa. U
Signature of Contractor or Owner- Builder Date
c "`dt- - ce. ) ? -2 7, )
Notary as to Owner and/or Condo President Date otary as to Contractor or Owner- Builder
,psta My Commission Expires: My c•-. „•:• .. _ -
Master Permit #
Phone
Ins. Co.
, 3 7os
751
n q ,
Date
oD
FEES: PERMIT 4 1 / O. RADON C.C.F. rSO NOTARY OED - TOTAL DUE 1 1,S r
APPROVED:
Zonin g Building ti "j j /. 01 Electrical
Mechanical Plumbing Engineering