325 NE 96 St (8)Date Job Address
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant M Ar 5 UAIVIeS W C oy Tr.
Owner's A d d r e s s 326 Y e— 6 10 -1 " Street
Contracting Co.
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL of PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION PQ l l Y1 outside of res 1 GG v/ �/ �I 1 V t jy
Square Ft. 30OU Estimated Cost (value) 5
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 to do the work stated.
My Commission Expires:
FEES: PERMIT
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
,3 /g 9 Tax Folio
Address
ondo President Date Signature of ntractor owner- Builder
rehigh 1 r •• .RiDA
NOTARY PUBLIC
COMMISSION NO. CC714103
MY COMMISS1OI■ EXP. MAB. .7.r
Notary as to Contractor or Owner - Builder
My Commission Expires:
C.C.F. , 60 NOTARY
Master Permit # 3 .2/6
Phone 3 74 222 G(V)
365 7i _'t 2.77 4.ki 1t
BOND
E t i
`/ f
Dae
Date
TOTAL DUE
APPROVED: /
Zoning Building i` ��- y.r �J C
.. . df ectncal
Mechanical Plumbing / Engineering