760 NE 97 St (6)Date.
Legal Description A/ ' /
e ) / Lessee / Tenant /V' S
2MIT APPLICATION FOR MIAMI SHORES VILLAGE
Address 7 a 2-z... 9 .$
Owner's Address �G� C •�
Contracting Co. / /¢/yk / / , 9 lr//= f , 4 1 % ;� /Address i �� Sr
Qualifier
State #
Architect /Engineer
Bonding Company
Municipal # Competency # PLAII; P /Ins.Co.
Address
Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 7 / / / /G
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 an
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accu
be done in compliance with all applicable laws regulating construction
authorize the above -named contractor to do the work state
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
* * * * * * * *
FEES: PERMIT /$D RADON C.C.F. 1 1°6
APPROVED: Fire
Zoning Building
Mechanical Plumbing_
Tax Folio /4/ Ic6V I4 o laV
7
Signature o
Date:
Master Permit #3 °2 c7 /.,f--
/ 2",) Av Electrical
Engineering
Phone
ss# - - Phone '5
• `,P r iV
a t B ' • t t a '1 1 H te k will
pft 5;l!�c5 a of F .,
'� - �ri P nA•'Y SSIOTf : � "� � ,,, j .•,
CC197
n`£ractor or Owner- Builder
7 9 -7
as to Contractor or Owner- Builder
My Commission Expires:
NOTARY t 110 TOTAL DUE q$; v
Other