325 NE 96 St (9)�• J
Owner's Address
Contracting Co. LA,
Qualifier N“)
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date $ q 1 q,s Job Address 3dt S N E 9 6, Tax Folio /j' 3. 6 0/ 3 _s X 9 6
Legal Description )_— 9+5 /�S // (o .1 / K - •
Owner / Lessee / Tenant *1/4.5 454 /C P,-,
' - Phone - 7S - 78 - D 2 �a-
S P << y a- Address a-el L(3 Ai (.0 0
•u s3 1,, &u -me../ SS # Phone 9 —76-6 an
State #t b6O(a1 Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUIL ELECTR CAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
x � -
Square Ft. Estimated Cost(value) .t=p 1S
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 •.'u.liance with all applicable laws regulating construction and zoning. Furthermore, I
authorize th abo'- -named contractor to do the work stated!
** *
icy - - 'x. ' • -r- 8 do P sid
1111TbC 283698
My Comm. Expires Mey 6.1 i0'
(,e&
Master Permit # 3 ga 7 9
Signature of Contractor
Date:
; ........ DEBRA K. LADD
NOTARY PUBLIC
SIIrJLTE3OBER4R111Atractor or er- g uilder
* :!I t , 'CIII.NttPIaiC�i28311 Tres:
My Comm. Expires May 6,199
or Owner- Builder
FEES: PERMIT 33 ''d RADON C.C.F. i C(2) NOTARY r TOTAL DUE V
APPROVED:
Zoning
Mechanical
Fire
Other
Building Electrica
Plumbing_ Engineering