5 NE 96 St (4)PERMIT APPLICATION FOR MIAMI SHORES V]
Date -// - 6 v Job Address /S. /VEQ6 6 Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant ,t K,E,L2 A/ J ' ( z 77 / D Master Permit #
Owner's Address `�// /E Q 6 .c7 '7 ' a _ S ' , %a., Phone (30S) 3 4 6/.37 eta
Contracting Co �� ,� G�i 4 -� /� ��/� i a�( Address ,// f a / S aJ /% d
Qualife • ���'a�lc rte/•:% eig,' SS# - e - //x',1.5 Phone ,gd
State # Ade Municipal # 'chi - Competency 4,° 1 fws'cQ /.�/ Ins. Co. .Ay
Architect/Engineer Address
Bonding Company Address
Mortgagor , . Address
Permit Type (circle one 4 BUILDING) ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTIONX yPrt /7? -•.4,
3 T AB //1/ iCIh0Af *c260 ' TuCC -
Square Ft. Estimated Cost (value) / V ,7 /j , cy
WARNING TOO R: 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.
Notary
My Co
APPROVED:
Zoning
Mechanical
OWNERS AFFIDAVIT. certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construe ' •n auctioning,/ Furthermore, I at horize the above -named contractor to do the work stated.
owner : �, Condo President Date
' ,. , ili • n`. , - ; rw : Date
on xPUEPH RUIZ
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC895966
MY COMMISSION EXP. IAN. 9,2004
FEES: PERMIT O RADON
Building
C.C.F. ole? NOTARY BOND
TOTAL DUE 3 al-67
Contractor or Owner - Builder
otary as to _Co
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Date
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Plumbing Structural Engineer