126 NE 97 St (5)Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
'61 (n Job Address l 2-le 7 6' Meer Tax Folio
Legal Description //���� Historically Designated: Yes
Owner/Lessee / Tenant /t-C`XJ(s/4/ 06041/6A-9") Master Permit #
Owner's Address ` 6 , --io itit. 9 7 7 Phone 757 - o 'V
Contracting Co. er)v,t !A (r (, . Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION � A/ �aVssd r 40 45) 45) A/ ` 5 e
Square Ft. Estimated Cost (value) 4,5 pIJ
WARNING TO i! WNER: 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.
Signature /of owner and/or o President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT 'O , O c7 RADON
APPROVED:
Zoning
Mechanical
//1 44
Building
(4,1
Signatyfe of Contractor or 1r er- Builder
ep.-2
Notary as to Contractor or Owner- Builder Date
My (:attift ion E .
o t i
C.C.F. p k.1 NOTARY 5o 0 TOTAL DUE S®
Electrical
7- 1)16
Plumbing Engineering
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 5 Job Address I . 0.1 `77 ST • Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant Nj(? (Lj S U V `C L kV &l R eV.)
ac1 �Fa ' - i .
Contracting Co. 0 4J f \r Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION 6 JO V TS . 06 e 0 0 - 00 5
fi e/6 e -e--/41#r e z & (7)
Square Ft (b O Estimated Cost (value) J O C7
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; ating • tructi. d oning. Furthermore, I authorize the above -named contractor to do the work stated.
r J
A AZ
Signaxur- of owner an. or Condo ident
// II
Notary as td' • , S' an or Condo President Date
My Commissio i xpires:
P1 .2,,q6 ? /7 "C° ` (f6 - 6
N3 :.lki v.. J:4 r.._J4v4 '
FEES: PERMIT(. 12ADEN) C.C.F. a 6 0 NOTARY BOND
APPROVED:
Zoning Building
Mechanical
Plumbing
Date
�g
Master Permit # 2 0
Signature of Contractor or Owner - Builder
Electrical
TOTAL DUE
Phone - 151 — 0 P- (4 /392c-7-m76
Date
Notary as to Contractor or Owner - Builder Date
My Conunission Expires:
S: V
Engineering