260 NE 95 StPERMIT APPLICATION FOR MIAMI SHORES ( VILLAGE
Date (o C l Job Address Z 0 \Sk i Tax Folio e (U ( 3 1 2
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Legal Description �,G • � � b Pa IG -�'(� A� �z Historically Designated: Yes 4°4
/ Tenant ! CA_ Y � X . - N OL (C� Master Permit #
Owner's Address Phone � U 5 - - 1 Z
Address 1 O S S • PO
SS# * \ Phone GS 1 2
Contracting Co. S z c
Qualifier Ltf t are- . 5 — 3 — c) . (
State# S00 (,00`Q
Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDIN ELECTRI PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 13 1/4^ 9 `c‘it R ck( ✓�
M. U5 -kr - I R4 L tiLS
Square Ft. Estimated Cost (value / S o0
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 an
1 regulating construction and zoning. Furthermore, I authorize the above -n
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Signature of owner and/or Condo President
4 6 1
ate
Notary as to • er and/or Co 'resident
My Commission Expires:
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Competency # Ins. Co.
Address
Address
Si
f Contractor or
Notary as to Co" n or or Owner-
My Commission Expires:_ 4
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FEES: PERMIT �
° RADON C.C.F. NOTARY
e in co' •liance with all applicable
ated.
BOND
Date
Date
APPROVED:
Zoning Building Electrical eds'8
Mechanical Plumbing Engineering