43697PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / Dl ai[ Qf Job Address
Legal Description .�-,►+
Owner/Lessee / Tenant in r. 4rinr°s . CO* t7 1 t
/ a 9 � N. E. 9 7 Tax Folio
Historically Designated: Yes No X
4f3697
Master Permit #
O w n e r ' s A d d r e s s / L / N , . I . c .7 s T Phone 3 &S . '7e't 7'f 3 3
Adams 471-4'3 I lV . tom. 11 9
s �
C o n t r a c t i n g Co. J O 1410 1)3E." E12 /tours
Qualifier 14.1 Li) EEL SS# 3 DJ. 4,2 v._ /-7.71
S t a t e # M u n i c i p a l # C o m p e t e n c y # )199 f Ins. Co. 7 u r 11 ivc� / a 43
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL �ROOFING SAVING FENCE SIGN
WORK DESCRIPTION ,,. jZ,o o C Et4 K. it 5 E I PO t t LE. o f'
Square Ft .a$
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
4 p, e era
Estimated Cost (value) / b S�
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
�- /lZ.IJC�AJ. %I2. 1./ A A _L I b/ S/ 98
signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
F.D(Cf3b- 147- 3 &-- S23--()
boLDleE S 6: CT 7"72
FEES: PERMTT 0 RADON
APPROVED:
Zoning Building
Mechanical
Si
fC
Contractor or
oC1,Ia Y114
��8�1x�r9� gytS'FA�,}}T�E�OJ FLORIDA ��p
CO M ON NO. C 4lL
MY COMMISSION OiMF. MAR. 1,2O 2
%AAA- 1 ts !at 19.-
• er- Builder
36
otary as
My Co
11 10
Date
19-02S— f9
Date
C.C.F. ' NOTARY BOND
Electrical
TOTAL DUE
Plumbing Engineering