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1131 NE 97 St (2)'‘ 1 U ' APPLICATION FOR MIAMI SHORES VILLAGE Legal Description .10'6 Address ! 6 / /()E 97 . Tax Folio if 3-2 ® r r7© 0 6d ©wner Lessee / Tenant (/GA(-C (2. tr + Si L t-- !" �v .-'EL/ 1 Master Permit # 3,1 ✓Owner's Address 1 1 _3 1 /U.c. 9 5 Phone Contracting Co. '�1�47.4/y Address Qualifier SS# - - Phone State ifr Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN �W¢R DESCRIPTION P2 vet - l 'e' � s ILt, v� Square Ft. Estimated Cost(value) A5CC- 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 state Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: ** * * * * * * * * FEES: PERMIT ?(� RADON C.C.F. APPROVED: Fire Zonin ccx I F ; 2 (C,C- 6 /-1 c)S- Not igna r ctor .r Owner- Builder � JOSE?HIZE CHUR01 Date �J NOTARY tJ i re of Con ry as to C My Commission o ** TOTAL DUE �`� ' "" Other Electrical Mechanical Plumbing Engineering