1209 NE 96 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address \i, %() Tax Folio
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Contracting Co. \ \ \\NG \ `,k1) \ 1 j'L, Address
Qualifier Z C�f7X- /✓ ss# ? % Phone =3o5- &2-/ —6. /3/
State # , 2 )DZ) 3 0 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Date
Legal Description
Owner/Lessee / Tenant
Owner's Address
Mortgagor Address
Permit Type (circle one): BUILDIN L ECTRICA)o PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION %( I deL? /72,e 4 Q26 /? _
ature of owne and/or Co %o President
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Notary s to Owner and/or Condo President ate
My Commission Expires:
NOTARY PUBLIC, STATE OF FLORIDA.
MY COMMISSION EXPIRES: Oct. 5, 1995.
BONDED THRU NOTARY PUBLIC UNDERWRIT
FEES: PERMIT e4 RADON
Historically Designated: Yes
o
C.C.F. ` • NOTARY
Master Permit #
Phone
Square Ft. Estimated Cost (value) - v
No
X1 1 a0
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 regul construction and zo g. Furthermore, I authorize the above -named contractor to do the work stated.
,.6'al �-c i� 9
gn afore of Contractor or Owner- Builder ate
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Not to Contractor or Owner- Builder Date
My Co fission Expires:
NOTARY PUBLIC, STATE OF FLORIDA.
MY COMMISSION EXPIRES: Oct. 5, 1995.
BONDED THRU NOTARY PUBLIC UNDERWR! -
TOTAL DUE
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
(