615 NE 97 St (5)Square Ft. c l A , C)
** * * *
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date() Job Address 1 � �= ' Gi 7 Tax Folio 0 Jam" 6 / ✓ /(`-‘
Legal Description id `-/A/ /® / g_
Owner / Lessee / Tenant ` 2- ZIrfttcLO ik\ 1 c A Master Permit
Owner's Address (01 - L ST Phone 7 c —(U Contracting Co.a Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION A ! i YiJ
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 compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
/ < <
Signature of owner and /or Condo President igpr btu / // r, of, reete
Ce Owner- Builder
Date: Date: ,
�
Notary as to Owner and /or Condo President
My Commission Expires:
( 1' pp
Estimated Cost(value) 4 . fi,�
* * *
**
FEES: PERMIT- RADON C.C.P. / NOTARY 5 TOTAL DUE `/7 4 V
Fire Other
��,, : Buildin,7� Electrical
Zonin
Mechanical Pluming Engineering
3� � J2
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6`
tj
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date f )/4cff4C Job Address t! /fA/ 9 7 ST Tax Folio tit, 32 G —6/ 7
1193 4_1 /
Legal Description i / �p.J/ S',5 ftc55 $LGG 4 �M� P4istorically Designated: Yes No
-5 3 ale.! — t�, i $r 2c /&O)oc)X /3O
Owner/Lessee / Tenant / 9" • J-//) ( 1 w/21, Master Permit # 4 /0S - 70
(3&r) 7.3rz SVF
Contractin Co. l oc/c (A( EP- Address 36g- P.
Owner's Address 6 15 e a , 9 7 Si /Yarn 5/ 26c Phone
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION F #/ ii T/ lac X T E !e r o02. of Nd
Square Ft. Estimated Cost (value) i
B
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date S, r . ture of Co ctor or uilder
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder ) Date
My (omnrission- _Expires:_ _ -_ _ —_ - = -,
My Commission Expires:
FEES: .PERMIT
RADON C.C.F. � NOTARY cc. BOND 50
APPROVED:
Zoning Building
Mechanical Plumbing Engineering
Electrical
TOTAL DUE
Date
4