301 NE 93 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date,4' /99 Job Address �6/ ��9 `' I Tax Folio /1 -.' /3 / 3/ c
Legal
/7 ` 1f 7JS i l
L Description �j
C / ner / Lessee / Tenant C`n/A- O t Li t n) 2 1 a l3 cock Master Permit # 3 o d� .
Owner's Address 36 ( A) F q 3 Phone 1 S Li ^C° 3 3
n ( L i_E- R. '3 (., t / L3 • \ ct ? ST
o�Contracting Co. 1 \ 6� C (�� � Address
Qualifier SS# - - Phone L, S 3 - 3(a 2
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
1/WORK DESCRIPTION CA k '- X TE A, \ U a v V ' \- (J., S L
Square Ft. Estimated Cost(value( . O
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 contractor to do the work stated.
✓`YYI. a d aQ \ CJ co ( 2
Signatuure of owner and /or Condo President
Date: dWOY
Z�J4
tart' as to Owner at
Commission Expires
** * * * * * * * * * * * *
FEES: PERMIT 47ra RADON C.C.F. It To NOTARY 5-re
APPROVED:
JOSEPHINE CHURCH
•:iotary f ubfic, State of field.
n d q CPrRhe a+deipVoril 30, 1
$ No. CC197545
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
TOTAL DUE
DV
Fire Other
Zoning Building4 lj Electrical
Mechanical Plumbing Engineerin