1200 NE 97 St (7)1
Date ii i Job Address /ZOO NE /' 57 Tax Folio ! / D‘hD 0
1 4 LL. 1.—I
Owner / Lessee / Tenant A chi i-hetekiS
Legal Description
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Owner's Address /Z9 e; ,/A 97
Contracting Co.13 €4.D ( 00XVCre ®off ( Address
Qualifier 37 K I.'y SS# Phone . 72,-
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVIN PENCE SIGN
WORK DESCRIPTION R 9JPP Cf gizoW
P eo
Square Ft.1365 Estimated Cost(value) 1� NO
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
autho ze the above -named contractor to do the work stated.
Sign'ture of owner and /or Condo President
Date:
Notary as to Own r and
My Commission Expires:
.. �_, `*4f9XAL
SONi('. Z ODNEZ
NOT A IZY FUZIC (3 OS FLORIDA
CCMMISION N . C..CI7M7
** * * * * �R1dZf CO Q ^:a ^ #I1f'. e: _'i7_ %
APPROVED:
Zoning
RADON C.C.F. t g NOTARY TOTAL DUE '116 "
Fire Other
Building '. ''/ Electrical
Mechanical Plumbing_
Master Permit # 3J 1 e '7
Phone ',7C/..s '
Sigr<e of Contractor or Owner-Builder
Date:
/'
Notary as • ont 4 ctor or :Ow er- Builder
My Commission Expires:
ib / `' a'..,`.. ..
* * * -" * * * **
Engineering_
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