74 NE 97 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 7P /
Legal Description
Owner / Lessee / Tenant / �ZO L Y - Master Permit # 2,6
Owner's Address 7, 97 * s`�� / .-cr Phone
Contracting Co. /4)0 %'/M( Address S : - Y Al?) / -c f,
WORK DESCRIPTION
Si ature oftiO i@ nd/
Date: 1
M
r . dmm: ,N o. CC 20;,95$
Notary as t o bNndf• and /or Condo President
My Commission Expires:
APPROVED:
� 7e��
Qualifier I � SS4f ,, -. Phone � e- � ‘'-5
State I f " # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING BLECT$IG L PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
Square Ft. Estimated Cost(value)
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 -'1 the foregoing information is a urate and that al 'work will
be done in compliance with all apcable laws regulating construction a d zoning. F ,'hermore, I
aut •'r the above -named contra or to d• ork tated.
FEES: PERMIT RADON C.C.F.
Fire Other
Tax Folio
/3/
Signatu'e . bra > Io . •`�'' — .: uilder
Date: « M ommi ;- on ES
µ� • Ires
+" • u ,X4'
Notary aseMrContractor or Owner-Builder
My Commission Expirejs:
** * * * * * * * * * * * * * * * **
NOTARY TOTAL DUE lbe
Zoning Building Electrica1t1 )
Mechanical Plumbing Engineering