550 NE 102 St (10)Date e -0,-CirJob Address - i(& // & Tax Folio
Legal Description Historically Designated: Yes g No /f
Owner/Lessee / Tenant EU L_/ t Pe Z 0 Master Permit # 5 o °2 .
Owner's Address 515 /fit` 10 & 1 Phone 7 E 7--6 / &VW-94z ?
Contracting Co. 0 W/U LPL Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co. _
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
P MA, r et4 bae, cau_k_s
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
4(LutiLti.„ / t C� �'J
Signature of owner and/o l Endo Pre Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT t- RADON
/n t 7 iU i (9S
Square Ft. Estimated Cost (value) 0g6-
- 0 - �—
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 one 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 Contractor or O : er -Buil• r
otary a ontractor or 0
My Commission Expires:
r -Build
OFFIC_AL. NOI'A` Y SEAL
LIC'A H i:Tr:N `::QUE
NOTARY PUBLIC STA ': O P i OI IBt'.
COMMISSION NO. CCGC.', ?3
MY COMMISSION
C.C.F. C NOTARY TOTAL DUE 4 0,
Date
Date
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering