537 NE 96 St (4)Date
Square Ft.
Legal Description C S 155 + fo Block M & }1/' Historically Designated: Yes
Owner/Lessee / Tenant M are0 . ( Master Permit #
Owner's Address Fj 0 - '00414 u0. reo Phone • 13t7--.
Contracting Co. 'Y►/ Address
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLU BING MECHANIC ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 5j4Ary I/14 � 'i/'"'"• r E(4,irjo r LL
` j
ai,to 4t - err
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENr'vl"T"v
RESULT IN YOUR PAYING TWICE FOR IMPROVEMEI T -
CONSULT WITH YOUR LENDER OR AN ATTORNEY
Application is hereby made to obtain a permit to do work an
certify that all work will be performed to meet the standards
permits are required for ELECTRICAL, PLUMBING, SIGNS, :
O R'S AFF II, . V : I certify
law gulating • s ctio and zo
Viifeb
Signature of o
Otary as to4)wner and /nr Cnnrin Pram` 1
My Commi iOr"f : OFFICIAL NOTAR SEAL
e.e TRINIDAD ALVAREZ
O * COMMISSION NUMBER
CC390225
cb MY COMMISSION EXP.
OF OP SEPT 5,1998
FEES: PERMIT
PERMIT APPLICATION FOR MIAMI SHORES VILLAOA ,
Job Address 55 14.6 . qtAt � . Tax Folio
v+/a.
r and/. Condo 'resident
v. /ct
RADON
Municipal # vt Ja
all the foregoing inforn at all work will be done in compliance with all applicable
Furthermore, I authorize the above -named contractor to do the work stated.
01/
C.C.F.
APPROVED:
Zoning Building " t
1
SS#
_ / _
Address
Address
Address
Competency # Ins. Co.
Estimated Cost (value)
3/c
A
Phone
42 1,2x 61/9(
Signature of Contractor or Owner- Builder
Notary as to Contractor or Owner - Builder
My Commission Expires:
NOTARY
Electrical
No
3R,
UR FAILURE TO DO SO MAY
END TO OBTAIN FINANCING,
OF COMMENCEMENT.)
ttached addendum (if applicable). I
lction. I understand that separate
Date
Date
TOTAL DUE Lit- 66
Mechanical Plumbing Engineering
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