443 NE 95 St (3)PERMIT APPLICATION FOR MIAMI SHORES VI
Date / /C/E5 Job Address L 3 NE c15 +h S - + Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant M io 5 ho re 5 y p t 5+ C hurch Master Permit # •
Owner's Address 'f i f 7 q i=, a c h �7
WORK DESCRIP'T'ION l r 1- e
Signature of owner and/or Condo President
Date Signature of
Phone ( ) '7 513 - U 5c1
( poi ., rC
ontractor or OvAter- Builder
Square Ft. Estimated Cost (value) ..4 gib .
Phone
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Date
Contracting Co. (5 /Al L ,2 Address
Qualifier SS#
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
NOY d Shvf} -u-S e
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 ELECTRCAL, 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.
Notary as to Owner and/or Condo President Date otary as to Contractor or Owner- Builder Da � p
My Commission Expires: My Commission Expires: // -3 �C
,PR Pu OFFICIAL NOTARY SEAL
2 �r < � SANDRA M MONTIEL
' x COMMISSION NUMBER
i' , CC401261 ke
si..■ MY COMMISSION .EXP.
If
FEES: PERMIT L e ' RADON C.C.F. 1 0 NOTARY ,15 °c' Boicli
APPROVED:
Zoning Building ' ! i ,' Electrical
Mechanical Plumbing Engineering