1250 NE 97 St (12)PERMIT APPLICATION FOR MIAMI SHORES VILI
Date Oa3ob Address %a, 5(). 7 Q ) S Tax Folio
Legal Description
Owner's Address /0 Sd 71 Sf
Permit Type (circle one):
Contracting Co. /
Qualifier
State # Municipal # Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Historically Designated: Yes No
Owner/Lessee / Tenant / //Pm h ,k hCl-4 Master Pennit # 4.2(0"1
Phone (340 75 Y
Address
SS# (
Ins. Co.
BVILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE a SIGN
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WORK DESCRIPTION
„LiA; )
Square Ft. Estimated Cost (value) "
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT A,ND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WTTH 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.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT .e /t 3 RADON C.C.F.
" 'WED:
Building
Plumbing
Electrical
Ll ) Cl�/ 9 c 9/4 �
S of Contractor or Owner- Builder Date
Notary as to Contractor or Owner- Builder Date
My C....::.. __.. wires:
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P 60 NOTARY — BOND
TOTAL DUE �f.
Engineering