839 NE 97 St (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ////340 7 Job Address 739 ive 97 -5J Tax Folio
Legal Description Historically Designated: Yes No L
Owner/Lessee / Tenant /1/44 C / L/
Phone (.305) 7J /D 0_r--
Contracting Co. Q7tit�[ c"�� /74 ) M d./Address /'? /3a
QualifierPi J
State # Municipal # Competency # O /W- Ins. Co. £7T/,E
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one):
WORK DESCRIPTION
Owner's Address
APPROVED:
Zoning
Mechanical
,39 AO 9 ,-574 .
Signature of owner
?
Notary as to r and/or Condo
My Commission Expires:
FEES: PERMIT (p Q ,, RADON
BUILDING
,•j Q =F
GJ
ELECTRICAL PLUMBING
do sident a te
Building
sident ate
ss# / Phone 5 i3 /8
op 6t] al
otary
My Co
to Con
ssio
Electrical
Master Permit #
MECHANICAL ROOFING PAVING FENCE SIGN
&c)
Square Ft. Estimated Cost (value) Z
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.
Q �
; d ` - z- 6//602/
Sig of Contractor or Owner -B ' er Date
L DL 1 -01— 4o s4 - aa) - o
ak %j
er-Builder
OFFICIAL iNO,AFIY )EAl
, eS$U6''e ANGELA 0 BECKER
2 cutteas•w NUry8EI,
T Q CC786697
yl cis OF CO4f.F JSSION EIPI ES
OF FA O NOV. 15,2002 r '
C.C.F. ) . % 6 NOTARY 5.4., OQ BOND
TOTAL DUE 4,k4)0
Plumbing Structural Engineer
DATE: 1/
OWNER'S N
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
ADDRESS: (3 /Ilf
//20
No c
-6
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: X39 ^`t q7 - fr
CONTRACTOR & LICENSE (i applic ble) O y /3/
COMPANY NAME: C / / PHONE: e"
* * * * * * * * * * * * * * * * * * * * ** ***********4**** *0*********************
All Elements on the site must be listed and indicate the color to be painted.
Walls
Fascia
Soffit
- /22/
Roof /1/if
Flower Bins Gtr //7'
Shutters /27/
Awnings /v/ }'
Chimney /L //I"
Doors and door jams Gat fa
Garage Doors jolt e
Railings
Fences ti /e
Decorative Metal /v/
All brick (simulated or regular) /./6y
Stucco Banding /„ / 6 9"
Any other stucco features A/ 7"
Accessory Buildings J"
Other /1//
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
samples. /
9 e lX "" ///3 00 714 �I / / /j// 4
Signature of O er Date Signature of Co actor
***************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPR •,VED:
l
Buil s mg Official Date
PHONE- 3QT- 70— /40 S
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