761 NE 95 St (5)PERMIT APPLICATION FOR MIAMI SHORE
Job AddresTax Folio
Legal Description Historically Designated: Yes -
Owner/Lessee / Tenant X- L L Pterel (,lQA(fi,() Master P
Owner's Address Phone ](
Contracting Co. ��t� Address / "
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one
WORK DESCRIPTION
APPROVED:
Zoning
Mechanical
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firM tai to
Square Ft.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT > U RADON
Address
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
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Pcc'rn1 Ao0F white. ±o w t'l ' c m
Estimated Cost (value)
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Building Electrical
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of Contractor or Owner - Builder
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w app
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Notary as to Con or or Owner - Builder
My Commission Expires:
DD S r C(t°et7 @% e V)
Q' -'4 ve t t U E / Pd r '
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C.C.F. NOTARY , ] BOND
TOTAL DUE 5— s- 6c7
Date
Plumbing Structural Engineer
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.
i
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be d ne compliance th 11 licable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to d e w. k stated.