325 NE 97 St (5)Date
Legal Description /.5;1 & o i c ./t.J .e-z../ -j 4 41 /7 Historically Designated: Yes
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Owner/Lessee / Tenant )et/ 4 S *rr< v f P s r 4 S, / r u e s' o , Master Pe #
Qualifi
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
.41; Job Address a2 u /(e? Qf 7 S I — Tax Folio // - 3 0 • - 0/9 ._ 7
Owner's Address 3.2 we e • 4'7 S` V(4 g�] 0 Y ' ' SPhone
Contracting Co. Ca /7 p S v Pe) 0 /
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State # 12 0 0 6 6 66 Municipal #
Architect/Engineer /
Bonding Company
Mortgagor
Address 7 9 3 Yl (_Q 3 O XS' 4 V / 7
Phone Zr),S - �:? t:�, - �/6 S' a.
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o -/ `9 % 3 7 / / Competency #q3 01 U J / 5 Ins. Coll ��� C i tr /i`
G1 S Cd �U O � 4 7I e S Address 7..x. % ` E-9 vi4
Permit Type (circle on BUILD ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION W / VLl /1/1 ; ).J PO c9-k a -/C
Square Ft. 1.= 7 Estimated Cost (value) 9 )To U ®O
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 AFF IP AVIT: I certify that all the foregoing information is accuratee/ ana that all ork will be done in compliance with all applicable
laws regulating c ns •Lion and zoning. Furthermore, I authorize the above -n edicontractor to do the work stated.
d
' 3 a4 0 , :
r
own r d/or Condo
FEES: PERMIT L J L' RADON
Date
Notary as to Owner artd/or Condo President Date
My C mmissionE,ires:
APPROVED: > A v�S1o�
Zoning �.�� -ie Building t/
Mechanical Plumbing
C.C.F.
Address
ddress
No
Signature of Co tr Date
Date
TOTAL DUE ri > e
Electrical
Engineering
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