350 NE 95 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date (o Job Address 5c ,0 ) , I qd
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant CC .( A frnK Master Permit # yip
Owner's Address ",C F)(*) `1 eGT Phone (O5 `1 51
it Nei i nC) Address nn < L G 4-r -1-
Contracting Co. rcperno,n Qualifier Jr3f SS# - - {" Phone km qO-O-
State # f401 9 I I I Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
FEES: PE
Square Ft. Estimated Cost (value) C ,
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 wor tated.
/
er and/or Condo
i ! L
. tary as to 0 d/or Condo Pre iident
y Commissis , s ires:
OFFICIAL L NOTARY SEAL
,PQV P U6 LINDA 0 ODOM
21 �. j}
3r C$ cOMMISMON NUMBER
CC804583
9j ' a cp ITV COMMISSION EXPIRES
' co .
7t o�
09_ r,k -- Of) 410 . a
resident Date
OF F.
FEB. 7,2003
RADON
(A)
ax Folio 1.5A0(00( a s c 2 ;()
s to Contractor
ommission Exp
��
C.C.F. 14 b NOTARY — O
APPROVED:
Zoning Building
Mechanical
Electrical
to a )
er- Builder
ate
o)
1 PRV P U B C LINDA D 0 NOTARY ODOM
61/4.
*
COMMON NUMBER
CC804583
UI'ni
F MV COMMISSION EXPIRES
OF fv0 FEB. 7,2003
BOND
TOTAL DUE
6
�' (P . �' . c ') Plumbing Engineering