1045 NE 97 St (15)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date �', t° 7 � F 7ob Address /n ) q_c e Tax Folio
Legal Descri• Jam Historically Designated: Yes No
Owner /Lessee / Teatan2 ____,16., � "/ r2 Master Permit # QQ 0 '9
Owner's Address /014.0 ,/V 4t: ° ? 4 ° Phone ° 7. g - ` 0
Contracting Co. / ex k" c. 1 3(,v,, i C — Address / 9 ` 2- o '')• c
Qualifier 54."64 - Ce:' ' 1/4' SS# 50 - 1.- - 6 7 2Phone 3 ° 41' 7€57
State #
Architect/Engineer Address
Bonging Company Address
Mortgagor Address
Permit Type (circle one): BUILD ELECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION - e e /oL
Square Ft. Estimated Cost (value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUL
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY OF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOTJR LENDER
OR AN ATTORNEY IEFORE 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.
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
con truction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
FEES: PERMIT
APPROVED:
Zoning
ti Mechanical
Notary as to Owner and/or Condo President Dat
My Commission ExL'r• �����, ���
Municipal
STEM-1EN E COCX1fUC
Stato of Florida
iUy Comm. E p: C® /34/0
ommr /: CC369Z
RADON
Competency # Ins. Co.
Signature of Contractor or Owner- Builder
C.C.F. � NOTARY 5 BOND 300
TOTAL DUE
Electrical
Ra te
: as to C., `f sit 15 • tt4" ' 1
C �pN11EL � Date �
My Commissio c ' G ��
n oox+srow y us�sE a �^
u, CC797277
�f „R ' � � fSSlO EXP mE.S
`cOF F` O DEC. 97,2002
Structural Engineer