541 NE 102 StDate -( '���
Legal Descriptio
Owner / Lessee / Tenant
Owner's Address
Contracting Co.ie?'
Qualifier
S
Notary as to
My Commission
** * *
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address
deL
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/'2 S7 ` . --T3 e3 Y
S�.aatfe Address
SS4 - - _ Phone
State #6,Pwo O Mffr(icipal 4k Competency # Ins.Co.
Architect /Engineer Addres�s-
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING (ILECTRICAL)PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
/ -61- " r-
/-
Square Ft. Estimated Cost(value) �0�
WORK DESCRIPTION
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W ,.. au
ire o OFFICIAL. NOTARY SEAL
1(r Sl,* i» COMMISSION F3UMSER
°„ a CC34864t
O MY COMMIGSIC*1 P
OF .. - -._ MAR. 1 iVen
°#.-17
ture of owner an ndo President
FEES: PERMIT
Zoning
tivint2 Master Permit 4t
3 7732
Fire
Building
Mechanical Plumbing_
Tax Folio /1-" ) ��p —Of [ —p9(,—
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 :.one in -- mpliaxncc with all applicable laws regulating construction and zoning. Furthermore. I
authori.- e above-named contractor to do the work stated.
d'ontractor or Owner- Builder
Signature o
Date:
134.4.�..i...�sa..
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c? !CIA. NO Ntl $ AL
rn. x • z E`s : SAMNA P' 111114;c'W
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COMMISU.ION NUMIJGR
7,, @ I CC 'IN ; * ; f�
.,ItN il
ary as t
My Commissi
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Phone / S'7'5 z
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Other
Electricall
er
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RADON ,C.C.F. NOTARY TOTAL DUE ') I
4 1
Engineering