574 NE 102 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Legal Description 26 7 3 /3 /0 (. ._ 9<1 Nk /S Pi Historically Designated: Yes
/Tenant s3L4 5ft I - o rc - e./t-
Owner's Address 5,4,rn.e_
Contracting Co. CA-5 Cv.L, 5 1 - h)5„J - 5 1 a c
Qualifier 3 Q, A O CA s
O L • TARY SEAL
to .r SS1on jXPJ DRA M MONTIEL
j ;�� * COMMISSION NUMBER
I �' • % � CC401261
171.0F ' cr... MY COMMISSION .EXP.
OP AUG. 17 1998
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Signature of owner
Not
My
d/or Condo President
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e
Date
Master Permit #
No X
�77s3
Phone 75 S g s
Address 4'6 1 :4 -(Co. Ave 1 S/),(. 5
SS# Phone O g`/ —(2V
State # C C-7 C. Municipal # Competency # Ins. Co.
Architect/Engineer /i-- Address
Bonding Company Address
Mortgagor Address
Permit Type (circle on '1: BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION f fr5.fn // . l /A- i 'Dti1 0 -( (4. e.f5 d"' cn
Square Ft. Estimated Cost (value) fo
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
regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
ignature of Contractor or Owner- Builder
.e.
lion
gf)CIAL NOTARY SEAL
,Z I' n SANDRA M MONTIEL
* 4 * COMMISSION NUMBER
C CC401261
F OF F`A MY COMMISSION .EXP.
AUG. 17 1998
Notary
My Co
Date
'lder Date
MAF ;16-95 THU 12:21 PM Home Depot #251 FAX ISO. 305 919 1417
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f hIs Is an original design and must ANC
got be released or copied un :ess SUSAN PORTER
applicable lee has been pad or job 574 NE 102 ST
DrGer placed. MIAMI SHORES FL 33138
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Date : 03/04/95