9301 NE 9 Pl (6)Date Job Address `3Di 1 ?L
Tax Foli � /"' /�E
Legal Description
Owner/ Lessee / Tenant
Owner's Address 30 II 017- Phone r' <? 7 /
Contracting Co ,1'/..1. !..4.1_41 "
..1.. Address
Qualifier
SS;k Phone Z5 - 2,s —
State 'r /, M2(Q6 /.3Munic:pa'_ Competency 4 :ns.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): 3U1LDIN�.ELECiRIC .,UMBING MECHANICAL ROOFING PAVING FENCE S
WORK DE S CR I PT I ON 407 ., O
'77 -
Sig
Dat
t ary as to
My Commissio
** * *
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
L'ut S 14&JC4LA J 4
owner and /or Congo President
-�- eR I N N IPS
A-me
Olc�' nd S' IN H
z •,
'` ( j ' COMMISSION NUMBER
l. ,, Q CC714091
(.,t Y COMMISSION EXPIRES
F AO * MAR. *I 2002*
dent
PEES__, 4? RADON
m.e0,an; ral
*
Master Permit 1/"
Square Ft. Estimated Cost(value)�i�/
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
30 MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INT:
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y(
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above,
on the attached addendum (if applicable). I certify that all work will be performed to meet
standards of all laws regulating construction in this jurisdiction. I 'understand that sepal
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 %
be done in compliance with all applicable laws regulating construction and zoning. Purthermorl
auth•rize the above -named contractor to do the work stated.
'r:1* i v .
Signature o
Dat ••
Contractor or Owner Buildel
/.
�• o uilde1
Notary as
COMMISSION NUMBER
My Commis. .. V'
; •es: CC714091
4 r ' 4 MY COMMISSION EXPIRES �
of MAR. 1 2n0
C.C.F. NOTARY TOTAL DUE
Fire Other
Building
Plumbing
Engineering