1075 NE 96 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address /(b 75 /VL 96 S7 - Tax Folio
Legal Description Historically Designated: Yes No_
Owner /Lessee / Tenant G&l6f/Z/iti Master Permit # 7 6'
Owners Address /0 75 A4 9' J •
Contracting Co. eO »7fGE-riE #75
Qualifier Mr do 7 - €4/09.f 7 c
Competency # D/f/ /3 /
Address
Bonding Comfy Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ! ' C41 R/ Qf GV J 7/712
rr.- J / fce 2 . &e' e_J
Square Ft. Estimated Cost (value)
State # Municipal #
Architect/En
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
President
c yi
Notary as to
My Commission
APPROVED:
Zoning
Mechanical
eer
1 7 4 f 7
(e a3y4tlus �bnsio ttRA ASKEWYCZ
`f'.= MY rr !SS!0N & CC 721000
EXPIRES: April 10, 2002
;4',of �.4"V Bonded Thru Notary Patio Underwriters
FEES: PERMIT RADON
Building
y/7/9 7
Date
Phone
/4 VV /o 17 H/ 33/6 /
3os- 389 -99
SS# / "Phone 3OT Gr7S /-
Address
Electrical
z /d
3
Signature . Contractor or Owner -Bui
.2 p 5 2 — i
N as to Con Cdr or .:�
y Commission E ues: CLAM'S; Y U-All
COMM' SIGN N . CC7 4fl3
1_ Pd1Y COMMISSTONI EXP. MA:g• 1 'Ja2
C.C.F. ` NOTARY BOND
Ins. Co. 4 izJ r', S
1 //i/ 9 1
Date
t /
— 02 3- - 9
Date
Plumbing Structural Engineer
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