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558 NE 94 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE o b Address S — t ) v v e / L i ( 4 Tax Folio i (.V0(01! V q3 r � V Legal Description . iaores Owner/Lessee / Tenant Q I CeJ0 Master Permit # � �, tf g�j/ Owner's Address G J a Phone L) 1- I D f .��_�, �� - �d �� Co trackin . � ��," Address Nu) 1 SS# Phone`►" 1 O AQ( State # /(), M n 'cipal # Competency # Date,3)2,141C0 Architect/Engineer Address Bonding Company Address Mortgagor Address Historically Designated: Yes No Square Ft. Estimated Cost (value) Ins. Co. Permit Type (circle one) BUILD t : ELECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION �l.V l 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. Q Signature of owner and/or Condo dent Aft /Iry lit Notary ;? : Date My Coniknissi IOC © ; '', FEES: PERMIT .6 P and RADON L3 O0 Date Signature of Contractor or Owner-Builder Notary as to Contractor or Ownet- Builder My Conuni i&E*plfe9 = 3 )L4 Date 3 V400 Date C.C.F. NOTARY BOND TOTAL DUE SC? � APPROVED: Zoning Building Electrical Mechanical Plumbing Structural Engineer