30 NE 97 St (7)air
1 MIAMI SHORES VILLAGE
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Tax Folio
�gffi vescription 1 To N 1 — 1 733 ��9' Historically Designated: Yes No
Owner/Lessee / Tenant J f 'c i (J t1 - 'C 5 '6
Master Permit #
Owner's Address 30 3L- 9 7 (e ( z- t` — Phone C Zi ( —02776
Contracting Co. _c- Address SPcix.cz
Qualifier Stec1n SS# -"57 - g - (4SZ.PhoneC364 0 ( — 277(,
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 P4 T - Ste- C1 X r t
Square Ft. 2. S Estimated Cost (value) 4,3
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 authorize the above -named contractor o the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
actor or • er- Builder
Date
Notary as to Contractor or Owner- Builder Date
My Commission Expires:
` PaV P0 OFFICIAL NOTARY SEAL
2 (.r<0 SCOTT W DAVIS
fi * COMMISSION NUMBER
• CC255237
• MY COMMISSION EXP.
0 F FLo JAN. 26 1997