595 NE 96 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE -
Date (P /o0 Job Address 515 /V 2' 96 S L J • Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant —/® /' f e ,4' "(3:44.//e
Master Pennit #
I- rrE fo 1<(.1 I- -IST,E.
`4 15 1(Z
Owner's Address 73 -e 7,7 S /Ud / ?j ,d ve • )4 fl DG) S Phone () S 3
Contracting Co. b Y I x t£ 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 / Ga! [ ' /7 C'/'? G! � " ' -P/ ( / - "? l /S ,
Square Ft. Estimated Cost (value) y o 0-
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 Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder
My Commission Expires: My Commission Expires:
FEES: PERMIT 1.10 RADON
APPROVED:
Zoning Building
Mechanical Plumbing
0D
C.C.F. - 6, o NOTARY 5 ' BOND
Electrical
Date
^ 3 _51-7
TOTAL DUE t -{ S •
Engineering