655 NE 97 St (12)• ,
Date / SJob Address
Legal Description
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Owner/Lessee / Tenant
Owner's Address
Contracting Co.
Qualifier
° gna e o owner and/or C.ndo "resident
APPROVED:
Zoning
Mechanical
Notary as to Owner an�olC �r5 . 5i� y " ate
My Co 601itptres ,rvinurise 1-fiugh
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a >' Notary Public, State of Florida �<
. wsy a` Commission No. CC 600341 )
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Bonded Through Fla. Notary Service & y Bonding Co. <
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FEES: PERMIT qv, RADON
PERMIT APPLICATION FOR MIAMI SHORES VILL
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Bonding Company
Mortgagor
Permit Type (circle one):
WORK DESCRIPTION
Building
Historically Designated: Yes
6 64N 145 1 //>✓(n/G CO Address
Square Ft. _3 0 Estimated Cost (value)
Not
My
C.C.F. s b' 0 NOTARY
No
Phone .os 7 /— 7 7 S v
Master Permit #
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SS# Jos" 75/ Lf- / G
State # Municipal # Competency # 0.-0:9 Ins. Co.
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Architect/Engineer 6 Q ' P Address (2) I S g Cr „ 2k f >J44-4
Address
Address
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
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$ 7c2 0
WARNING TO OWNER: YOU MUST RECO'':D 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- n do the work stated.
Signature of Contractor or Owner - Builder
I�.d+gctt'dflurct� udder T><
ur fps. +n Expu lie, State of Florida ��
Nom mission No. CC 6003
` Commission 11/1112000 �;
'>FnFc‘5) My Commission Exp. Bonding ?<
Bonded Thiough Fla Norm Service &
Electrical
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Date
Date
TOTAL DUE yo
Plumbing Engineering