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41 NE 95 St (2)Date 3 8 9 Legal Description Historically Designated: Yes No Owner/Lessee / Tenant 1 yo/ 4 //ufl L L / � Master Permit # ` 125 / ,� —T Owner's Address 4 / f ti L I ' ,5 11-1-1 5 t /v/g,,,, ore Phone Contracting Co. /✓x'IA„) e.TT &/ t.4 'S Address /C A — 6 J // 7 Ove A - 6 i 'M4 / L Qualifier / /,W / CIVA// ss# / Phone t 2 30 — 7 3 o / State# CGC GA.s.a U o77 . 'fir ERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 1 1 I A)6 2'5 Tax Folio Architect/Engineer Bonding Company Mortgagor Permit Type (circle one): IUILD ELECTRICAL PLUMBING MEC CAL RO FING PAVING FENCE SIGN WORK DESCRIPTION �e'O 4C ere? erg I ri ocoS t der r' l p/eQ (.� oct5- n1 .d rtcah.e. l Square Ft. Estimated Cost (value) 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. Sign ...IL/ ilfi �Zery Notary as to Owner and/or Condo • res • t Date My Commission Expir _,— My Co .01 Y P(/ OFFICE NOTfs.vY C:, 2 ..0‘.1,„_, l T BARBARA ANN FUGAZI N • �1U� * COMMISSION NUMSE.I CC360191 7, © , MY COMMISSION EXP. Q F_�l, `2.��Pr� FEES: PERMIT Municipal # Building ate ' J Zv '.-[ 0 RADON C.C.F. NOTARY S APPROVED: Zoning Mechanical Plumbing ft Competency # Ins. Co. Address Address Address Electrical Signature of� Actor t er -B ilder Date \ \ O 0 \ �,, `` 1E /fri \;4 I tSS10ry • • i OC `1 3 er- Buildei : a< � X 9 2 to :_ Aires: _ * • �. • y #CC 667290 • z Q BOND TOTAL DUE 3A/Fer-' Engineering