139 NE 96 St (8)`ite Job Address 1``" /4
/ — — Tax Nolio�� /.
.gal Description
wrier / Lessee / Tenant
wner's Address
Dntracting Co
aalifier, - ✓ r '
PROVED:
/77
1.
gnature of owner and /or ndo President
star as "'
y "iriiiI s q reds dent
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ES: PERMIT -�- /'' -" RADON
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
*
* *
Notary a
My Commi
tate 1f4 MQnicipal It Competency 4fr Ins.Co.
rchitect /Engineer Address
ending Company Address
)rtgagor Address
!rmit Type(circle one): =DING E ECT; PLUMBING MECHANICAL ROOFING PAVING FENCE SIG
1
)RK DESCRIPTION
*
C.C.F.
Fire Other
Building{
Mast -�r Permit: /l
Lif . 4
Phone � ��
Phone
y '
luare Ft. Estimated Cost(val
1RNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO D
MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEN
) OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU
)TICE OF COMMENCEMENT).
)plication is hereby made to obtain a permit to do work and installation as indicated above, ar .
the attached addendum (if applicable). I certify that all work will be performed to meet tt
andards of all laws regulating construction in this jurisdiction. I understand that separat
!rmits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING - and MECHANICAL WORK.
TNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wil
done in compliance with all applicable laws regulating const ction and zoning. Furthermore,
ithorize the above med contractor to do the work st tei.
NOTARY TOTAL DUE V e°
**
Mechanical Plumbing Engineering
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