574 NE 102 St (9)Date L , /�1 1 9 J Job Address
Owner / Lessee / Tenant /d/ -/rife
Owner's Address
Contracting Co.
Qualifier
WORK DESCRIPTION
S
D
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
•
kyi
Notary a'9.; • .�!� ' et 0
on
My Commissi Expires:
,/g
o ) 01" rondo President
4 !. 4
r
li
n 'r 'd iWo President
N CC 205953
! 7f' /l /
�/. _ �I I
ature j. qe r and/
ate: OFFI
Tax Polio
Legal Description
SS4t / Phone
P ie//?e,./
Master Permit # 3 77 /
Phone
Address J7 � � /�Gr� /i �� •
State 4r~ E��� # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILD�,NG LE,CTRIC: PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost(valueW,
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 :nd MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is a curate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. urthermore, I
aut•. ize the above-named contractor to do the work stated.
My Commission Expires:
Sig • tur' gnEr- Builder
Date: * I + ff ROBLFS
, , M • on Expires
�/.Y ,
.�;!,.iv,:.- Q 1996
Notary a • o'.Cont ac 6 " b • 3 Builder
** * * * * * * * * * * * * * * * *
FEES: PERMIT �D- RADON C.C.F. -5- o NOTARY TOTAL DUE -XI°
Fire Other
Zoning Building Electrical
Mechanical Plumbing Engineering