795 NE 95 St (4)Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
9 7 Job Address 795 IVE 1.5 31. Tax Folio
Legal Description / 4 of a0 6/k 6 r
Owner/Lessee / Tenant g1/21,, q
Owner's Address 79s /() E 9 S S f
Contracting Co. 5e A) i c.e. 7 - 3 OS 4 t .", c .
Qualifier , j E s e D� r_ ) o SS#
State # j - FDO 00 Municipal #
Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION A ti
Square Ft. Estimated Cost (value) A00. 00
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.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
Historically Designated:
Address (90 9 WE 33 St. 0.4044 044 P ✓k F/.
Phone ` .3,0.0 99
co/c, Dr c es
Mr �of Con or` or Owner- Builder
.1 Er/IV/
Notary as to C • r or Owner- Builder
My Commissi• -
Ol , pY rp
FEES: PERMIT RADON C.C.F. t P NOTARY
Yes
Master Permit #
No
Phone 305. 7,-$. — 7 '10 "4-
Ins. Co. j'{a�� �or .•�
H A STEWA - D JR
My Commission CC441325
Expires Feb 23, 1999
Bonded by ANB
800 -852 -5878
1/ / /�>
Date
Date
TOTAL DUE
3 J, 6v
APPROVED:
Zoning Building Electric
Mechanical Plumbing Engineering