560 NE 102 St (3)Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
ir/n� b Address F6O IN F ! OZ 5t Tax Folio ( - .9. o6 D/ ■
Owners t ."9 - �Cl M
Owner's Address 566 I lf"C� r ®2 si
Contracting Co. Ti
/ /" (1Mic
Qualifier / / /(. i /W7t L iPd/a/2 )
State # }T(�ZWC
Legal Description
Municipal #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICA
WORK DESCRIPTION /I ()hi
Square Ft. Estimated Cost (value)
of owner and/or Condo President
Notary as to Owr and/or Condo President
My Commissio Expires:
OFFICIAL NOTARY SEAL
TAMMY '1' RC/SS
NOTARY PIJ31..UC STATE OF FLORIDA
�.., : >•. ° :N., iS�i :; NO. CC75163
. ;ON EXP. UNE 15,2002
Date
FEES: PERMIT y .; 6---e RADON
V-c 797
Date
C.C.F.
APPROVED:
Zoning Building
Mechanical Plumbing
Historically Designated: Yes ' / No
Master Permit # Y 7 6 6r
Phone o5 -756 -826
Address /.0 ( P/ a666eh`.�,4
ss# /� 7 V
Competency # Ins. Co.
Address
Address
Address
PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
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.
Signatur
C
tractor or 0 ;. er- Builder
on Expires:
OFFICIAL NOTARY SEAL
TAMMY T ROSS
NarARY PUBLIC STATE OF FLORIDA
COMMISSIO NO. CC751631
MY COMMISSION EXP. UNE'NS,-
Notary as to
My Commi
NOTARY
Electric
wner- Builder
TOTAL DUE
Date
Engineering