489 NE 95 St (4)afge
Tre
mant
Owner's Address `f' ( 4 t 7 A
Contracting
Co. ? bhem/
Qualifier SS# - -
State # Municipal #
Signature of owner and /or Condo President
Date:
** * * 'J * * * * * * *
FEES: PERMIT , SO RADON C.C.F.
APPROVED: Fire
Zoning
PLICATION FOR MIAMI SHORES VILLAGE
Tax Folio 1� 5
Mechanical Plumbing
Address
Competency # Ins.Co.
Signatur
Date:a YV
-Q NOTARY
aggir A/.
Buildin
Master Permit # c3‘3%/ r
Phone / ,mod -Q z/'' 9
Phone
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION � r�1_4d
Square Ft. Estimated Cost(value) `WL740. 5&
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.
Notary as to Owner and /or Condo President Notary a to Contractor or Owner- Builder
My Commission Expires: My Commission Expires:
0 9 TOTAL DUE y'I /O1
Other
9 Electrical
Engineering
57'? O
5
s