1180 NE 97 St (8)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date f • i gi CK? Job Address 100 Ve 172 7 Tax Folio
,
Legal Description ` ,(� I /�
Owner/Lessee / Tenant � f �! i -,/ � C- / �'--
Architect/Engineer
Bonding Company
Mortgagor
WORK DE SCRIPTION
C °1/ / 7/
-yam
Signature of owner and/or Condo President Date
otary as to Owner and/or Condo President Date
My Commission Expires:
FOB 7 • /r-CD
K /9127; /,, 049
FEES: PERMIT
- 65uRE LG.E >pAJ PA /AY1
RADON
APPROVED:
Zoning
Mechanical
Historically Designated: Yes
Address
Address
Address
Square Ft. ,44f SO 0 Estimated Cost (value) Oal 0
Master Permit #
C.C.F. ` )` NOTARY -6 �`
Z,5'r.--. 3 7 0
Owner's Address /15 `JE 77 57 Phone
C o n t r a c t i n g Co. /?,0a017 1. o 134r Address / ( 7c / 6 / C , eitm L.
Qualifier /2 t /I «D SS# Phone
Ci
State # - � Municipal # Competency #/ r% P O Ins. Co. i9 j�� / 1(k .
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
O 5,9/w eo 'mart
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.
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.)
Notary as to Contractor or Owner- Builder
My Commission Expires
r
00
Signature of Contractor or Owner - Builder Date
Date
d27c /-0-/ -4
BOND
TOTAL DUE
Building ,A ( N .
Electrical
Plumbing Engineering