1096 NE 97 St (7)°ERMIT AAPPLICATION FOR MIAMI SHORES VILLAGE
Date /275 ob Address /09' / ' < / Tax Folio
Legal Description Historically Designated: Yes \ iNo)
Owner/Lessee / T Q ' Master Permit # q �
Owner's Address 6 �� `? . / Phon(�) 7 5 / 9 ?J-7 7J
Contracting Co. C3eC <° Address
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor N4
Permit Type (circle one
WORK DESCRIP'T'ION
Municip #
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BUILDIN ELECTRICA P UMBING MECHANICAL ROOFING PAVIN FENCE SIGN
__/,,, /mL. 6<Joal____
Square Ft. Estimated Cost (value)
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 ondo Presiden t ate
> Zezi
and/or Co do Pden
Notary as to Owner zf t
My Commission Exp
/o? V/97
Date
'0' P1/ 49 BARBARA ANN FUGAZZI
2 l �. ' 0 c iiSS ON =AB
a , j Q CC723468
-71.`e �� MY CO�SMtSSiON EP S
OF F\.O MAR. 29,2602
FEES: PERMIT 1 1 0 RADON C.C.F.
SS# Phone
Competency # Ins. Co.
Address 2 7g. NF ! D3 5r ,
Address
Address
APPROVED:
Zoning Buildui:� `- � } e7V
Mechanical Plumbing
Signature of Contractor or Owner- Builder
S'
Notary as to Contractor or Owner - Builder
My Commission Expires:
Electrical
aoVN.
Date
Date
e NOTARY .S . BOND
TOTAL DUE ' 2
Engineering
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