1196 NE 97 St (16)Date // Job Address // 9e A/C, 9 7 ,fi, Tax Folio /,/ .1 249 6 -. /7 0/ %0 .3
Legal Description 1 /1/ S / Y
Owner / Lessee / Tenant (4.&44L
Owner's Address / /96 A/ .E. 97 .4 Phone
Contracting Co. e , /th (53/, Address /0D7 IV . 4?A.L 0/4y
Qualifieri r r E /1� Phone /- 8 7' 9
`✓x . 3
State # Municipal # Competency # , X7..15 / s.Co. .577a re 1 star
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION T,E•„s-5QI 6 e2 94Ai 6
&-24w .T - �.v w,✓
Square Pt. aq
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.
0 -0 " ^'l -° �"—
Signat r of o er and /or Condo President
Date: OI /9/ 7 - -
31.13EPAM CHURCH
coarnsairanatke
No• 0197515
ary •s to Owner a
My Commission Expire
** *
AL PROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
* * *
r), Ail,' 7 rani
* *
0 -1141-44 ' dtt&Pl-
Fire
Zoning Building
Mechanical Plumbing
Estimated Cost(value) /6 SO. (22-
( ota , as to
My Commissio
Master Permit #334
Sign ure of Contractor or Owner- Builder
As:VF -1:N: M Lt
**
FEES: PERMIT . Y14 4 / RADON C.C.F. ) 46 NOTARY � TOTAL DUE 11
Other
;04/9'5 Electrical
Engineering