65 NE 96 St (4)Square Ft. Estimated Cost (value) W S A O
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE %C'
Date er - ? 3-7 Job Address By 6 I • , ST/ Tax Folio
Legal Description Historically Designated: Yes N.,__
Owner/Lessee / Tenant ". 0 0 1 - 5 / g/ g re4/4 6 Master Permit # 3 V : - >
Owner's Address Gi E- Phone 7,3'f- " Q 7 rf
Contracting Co. ®WA,/ IS 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 /4 r Alf 1"10 v S tZ a
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.
.;.ev, 3- 9,e
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERiN T 6(6 RADON
APPROVED:
Zoning
Mechanical
Building
Plumbing
C.C.F. - 0 NOTARY
Signature of Contractor or Owner- Builder Date
Notary as to Contractor or Owner- Builder
My Commission Expires:
Y d'U
'.( ,s
Electrical
Date
cfb
TOTAL DUE o l i o
Engineering
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Li
CONTRAC=CR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N° 6881
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description BI
Address of
Building
DATE 195
Contractor's
License No.
Work to be performed under this Permit
Subdi-
vision
Value of
Project $
I
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
portaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed. BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY