61 NE 102 St (2)/q)q4 Date O� Jo b Address (L7 Mg. ` D� J/� Tax Folio I i 32ob 13 I I� b O
Legal Description LT ICd- CAST 1 /2 orL r a 664, a2,
/ Lessee / Tenant kicALA 0() ;71 Master Permit # 36- 695 4 1 -
Owner's Address 61 /0,6° 1 D2 A) --Q �7 1 -1(,1 „97 s . Phone
Contracting Co. J u L ( 2,eGf--A Fr • l
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one)' :UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost(value) OO•�
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 abovq -named contractor do the work stated.
LeAlr
Sig ature of owner a
Dat � /S�
r�
Notary as to Owne
My Commission Exp
** *
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
-1\lST7 Pr7"' 04
ent
r_.°ondgrc eBri; P
* COMMISSION NUMBER
CC255237
�� aQ PA COMMISSION EXP.
D `'`c-1 ' ( qq _ 29 199
FEES: PERMIT l ' RADON C.C.F. " NOTARY / TOTAL DUE ViZer
Fire
Mechanical Plumbing
o f S A-TrE 1. 17Ls c/ / S fi 4-71) ti
Building
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * * **
Other
Electrical
Engineering