9600 NE 2 Ave (7)** * *
FEES: PERMIT 3
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
L Job Address )1'6 NE
go l i Tax Folio
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4Tena 5, 1 v ¢.r Tr'a iel Master Permit # 55P/
ci(oas 2.')D,R0E_ Sot
OWr2.f Address
SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION f l - Lk)1•1 ( Y0 Co
Square Pt. Estimated Cost(value)4
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 above -named contracto, to do the work stated.
I
Asp _41, 1:4111.141111matt
Signatur of owner and /or /Condo President
Date: 3I Z4/ `'/
*
Notary as to Owner and /or Condo President
My Commission Expires:
.0 % AV P(je OFFICIAL NOTARY SEAL
2 ��, , • ,.e% SCOTT W DAVIS
* COMMISSION NUMBER
* CC265237 *
F 4> MY COMMISSION EXP.
OF RP J a rty . 2 1 9
,
Fire
Zoning Buildin
Mechanical Plumbing,
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Phone 1 1S
- 9 ( 1, 1
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * **
NOTARY
i f/ 6§
TOTAL DUE t
Other
Electrical
Engineering
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