500 NE 97 St (4)Date 1 1 - 4- 9 S Job Address 5 D o !V f E. g T T a
Legal Description l
Historica
, i ,
/ Tenant
Owner's Address
Contracting Co.
Qualifier
State #
Architect/Engineer
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORE„
Municipal #
i
'?51
1 1'. .7
Address
a [MIG X
SS#
Competency # Ins. Co.
Address
Phone
FEES: PERMIT RADON C.C.F. • NOTARY BOND
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TOTAL DUE V /
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Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
5 J)1, 1 -t_i y,. �-r. / r v w i
S q u a r e Ft. , 5 0 0 ezi 41 . . Estimated Cost (value)}( & o o o
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOU::
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 regulatiu,,
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date 'Sims offontractor or Owner - Builder )date
Notary as to Owner and/or Condo President Date Notary as to Contrac
Ownerr044 I VII I r1R Date
My Commission Expires: My Commission ExpitOTARY PUBLIC STATE OF FLORIDA
, COMMISSION NO. CL7141C3
i MY COMMISSION F :P. M<W.1,7f..02
APPROVED:
"[ ( 3
Zoning Building , Electrical
Mechanical Plumbing Structural Engineer