568 NE 102 St (5)Date ' Job Address ,S4 4/ /0 . Tax Folio /1 3-206 /7 "/C
;� Its 5TAc. y
Owner / Lessee / Tenant J/O/V4 4 /' [ 7:f2A4,97.s?2D r5'f; 0 Master Permit #1 11(6.11
Owner's Address 5 /Vim /O I. Phone - ,5" ??- _2 Y 7.3
Contracting Co. Address s
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
WORK DESCRIPTION IK LO /i9c•,E F2 0 nit
Legal Description
Square Ft. Estimated Cost(value) jG `
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 stat
Signature*
Date:
*V
•
q \•�ll�'ii' Lot/
Notary as* to 'id and /or Condo President
yy Notary Public, State of Florida
M Ronded thr PECHARD Ins• Age
My Comtta>rxLE :
NOTARY PUBUC STATE OF FLORIDA
** * * *
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
and /or Condo President
FEES: PERMIT '2310 RADON
Mechanical
*
C.C.F.
Fire
Buildi
o v ��� , lII1 "' �
Notary aR441v
My Con nis 'ieRt *1x
DOLORES M.
NOTARY PUBUC STATE OF
N ®
Other
Electrical
Plumbing Engineering_
�
Signatur
Dat : • �'
tractor or Owner- Builder
ractor or Owner- Builder
VI P I BLE s
FLORIDA
No?fery Public, State of PIA►Id
MY Comisalon Expires Met, 4Q 4944
m
Hooded thru PICHARO IMPS. kr21 �
NOTARY TOTAL DUE 3 t P