702 NE 95 St (3)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 76.s. /✓s , Tax Folio
Legal Description Historically Designated: Yes No ,p
Owner/Lessee / Tenant —L I" / O Master Permit #
70 // � •� Phone
Owner's Address � 9 �� / � /
Contracting Co. / i ,I > Address ‘7 f v / /r e
Qualifier 23 SS #
State f/-b v a o 9-1-)
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ElCrBICAL- LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
FEES: PERMIT `' D
Municipal #
Signature of owner and/or Condo President Date
RADON
Competency #
Address
Address
Address
C.C.F.
Square Ft. Estimated Cost (value)
Notary as to Contra or 0
Notary as to Owner and/or Condo President Date
My Commission Expires: My Commission Expires:
V-1
071\'2--' n . r ki l i
*.1
Co.
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 acc - d that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -n•,i ed co actor to •r•, the work . ted.
NOTARY BOND
TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering