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1292 NE 95 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 69 7 - /G - 53 Job Address ( 2 4/� 5'5 S Legal Description i1 / Aei/ Ak -tc Z-e e '•? 6 l' (t) :1 7 ) / r er Lessee / Tenant G Master Permit # Owner's Address - /7 44 42 ' Contracting Co. ,4 / / GUf/0 Ic 4/L Qualifier J ©«'v J F1'v S�1.4.> State Oi vie Municipal # Architect /Engineer Bonding Company Mortgagor Permit Type(circle one WORK DESCRIPTION Tax Folio // 3 ' 2 e ) /`f Phone Address 4 7 / 2- G 2 56t) 7 3 14u& SS# -Phone 2 &' c e . 6 ? Competency # Ins .Co. AA/ PH I-24 Address Address Address : BUILDING ELECTRICAL PLUMBING CMECHANIC) ROOFING PAVING PENCE SIGN Square Ft. Estimated Cost(value) / ?Q 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 author4ize the ab ame,�i 96ntractor to do the work stated. ignature of own and /or Condo President Date: Notary( s to ('fvner and /or Condo President My Commission Expires: I� s�f+l,ON�75i $!�'eI'd��?li_'E'•S�r�%?�oD� a��� ** * * * * * * APPROVED: Zonin Mechanica Fire Sig n Date. tar as to Co My Commission E * * FEES: PERMIT. ViS7' RADON C.C.F. � "D NOTARY 5 .--4) ° 7 t4 rn e o tractor or Owner- Builder �pY !• 10S� PH1NE CH'1RCH * TOTAL DUE 0i .5 j ** Other Electrical Plumbing Engineering 3 7 eti '