1201 NE 97 St (5)wp
Date2 /4 P Job Address / N (? J *` Tax Folio 7 I 5a-40J o9 0320 �-
Legal Description
Owner / Lessee / Tenant /W5. 5 AJ Master Permit # - 5-4 ?e
Owner's Address /d9/ f7 Sf Phone
Contracting Co. M `*' a Address
Qualifier /
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVIN FENCE SIGN
WORK DESCRIPTION R i F4C./A(� etS671w dspMGr d
Square Ft . 6 2-
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
author' the above -named contractor to do the work stated
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
L o+
Signature of owner and /or Condo President Si
Date: Date:
** * *
Notary as to • er an
My Commission xpires:
NOTITY?J2 .'.0 ATE
COI: aaS .:: ?i. No C.Z1 s'''7
MY co V riioi+ f3: . ^ 34 i:s 4
FEES: PERMIT 70 RADON C.C.F.
APPROVED:
Fire Other
Zoning Buildin Electrical
Mechanical Plumbing
SS #Z, Phone 57 a 53°
Estimated Cost(value 7'
t54
Notary as to Cont ctor,or Owner- Builder
My Commission Expires:
NOTARY TOTAL DUE 3 VO
Engineering