9600 NE 2 Ave (11)PERMIT A PPLICATION FOR MIAMI SHORES VILLAGE
Date - /- Job Address l / 9 / //r f / 5 er Tax Folio
Legal Description f/ �� Historically Designated: Yes No
Owner/Lessee / Tenant Master Permit #
Owner's Address Phone
Contracting Co. r 4;4 ` Address 4/)5/V' / c / S7
Qualifier � — (( ( / f / ( SS# � ( 9
State # cAc0 3 1, ? O ( Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /�' /‘P e°C / C t=' a ce l 60,4 reit c GU
Square Ft. Estimated Cost (value) (1 & Y e • GlJ
f
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.
O NNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
law - pant. s nstruction and zoning. Furthermo authorize the above -n • s - . .• ntractor to do the work stated.
Ci to, of o • er and/or Condo President
JA.:
041!r'
Datq / / / 4 Signature of Contractor or Owner-Builder Date
gf P d '-)2 6 4-1(11
er . ; ndo President Dat Notary as to Contractor or Owner - Builder
, 7// /9/6 My Commission Expires:
1';!.1.:.`" , `''-- :12;2.!
CCMI I5:';i0N A.O. CC--
FEES: PERMIT 3 fr_ RADON C.C.F. 44 r NOTARY 3
BOND
TOTAL DUE
Date
/i
APPROVED:
Zoning Building Electrical
Mechanical Plumbing
Engineering