537 NE 96 St (6)Date Job Address
Legal Description
Owner / Lessee / Tenant
Owner's Address 5'37
Contracting Co. / F-%
Qualifier /1 A '
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
State # / 74iunicipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): UILDING LECTR L PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Zv
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 compl'ance with •11 applicable laws regulating constructio and zoning. Fu thermore, I
aut o tze the atibve amed L, tractor to do the work stated.
gna'ure of o ' '• /or - AettStt44 ent
Date: __• =- ROBLES
sion ExpUes
4, 1996
Notary as
P .if. Tax Folio
33/3/
tier Kt Notary as
Master Permit # 3 q�°
Phone
Address .5 /57 5
SS# / � Phone sri
Estimated Cost(value)
My Commission Expires: My Commission Expi es:
O
. • ; .
Signature o
Date:
L SEAL lder
ROBLES
s •`on Exaires
n 55- 410C2pgoier
** * * * * * * * * * * * * * * * **
FEES: PERMIT 30 . RADON C.C.P. �� NOTARY TOTAL DUE
APPROVED: Fire
Zoning Buildin f- Electrical
Mechanical Plumbing Engineering_
Other