ME-03-110 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E.2nd Avenue•Miami Shores,Florida 33138•Phone:305-795-2204• Fax:305-756-8972
Date 1`� ® Job Address l 19® /J ®1,)d db • Tax Folio 11-3005 ' OP-7 —®cl (p o
Legal Description Historically Designated: Yes No
Owner/Lessee/Tenet 17 1® LLL Master Permit# M 0 03 — 19
Owner's Address 119 o N 6 q,*:P Aad ^ Phone 305-25-7 —94 `f9
Contracting Co. fAWL 5 A rz, :Tfoc. Address J®a 1 5 LD to(? AA9_
Qualifier. ����L? Z� �r SS# Phone �J01 — o—LU LP ®��
State# Municipal# Competency# Ins.Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION.RE-INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
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WORK DESCRIPTION: Cf q I°l�.,
Square Ft. d Cost(value) "q 400
WARNING TO OWNER:YOU MUST RECORD �OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS OUR PROPERTY(IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH
YOUR LENDER OR ANY 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 all disciplines.
OWNERS 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.
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Signature of owner and/or Condo President ate Signature of Contr for or Owner Builder Date
XIA_Y-� e t�±Zw K ( ()--:s - 0-� 46-t�- 6/),g lb
Not ° owner r po?t� i n Date Notary as ° to ' w r Date
Notary a6 Q, .
mission# 6
My C s - §sion#CC v8 My ComB�fi +�� g pir 81 Sep. 1 2003
Expires Sep. 1,20o'
i�•• �A�� Bonded Thru
Bonded Thri; a�, °°°° Atlantic Bonding Co.,Inc.
ane° Atlantic Bonding Co.. jr,:
FEES:PERMIT 7r RADON C.C.F_4P_ 0 NOTARY BOND
APPROVED: TOTAL DUE
Zoning Building Electrical
Mechanical/' v 3 Plumbing Structural Engineer