882 NE 97 St (6)Date
Legal Description /� l /
Owner/Lessee / Tenant jean' .0 { e € /�
Owner's Address
Contracting Co.
Qualifier —1 r Iii .n/1 b0 / e- d► SS # C,Phone '
State # C C ( 0 T7 _Coll Municipal # 3 ..ry ra — (competency # Ins. Co. ( 0 c + efP,;?
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one
11
WORK DESCRIP'T'ION 9 -(/Lni r) 4 /d) S + f / (a r 1 l.Jh ,' -.e a (C. MI i n (4 '91 /C - f7 /I
rc / y
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.
9.
Signature of owner and/or Condo President Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE p�
Job Address g ��- /V £ 7 7 -S '- Tax Folio 1 1 • 3 � - C 14 ' d�7o
7 S? A)c 97
/e-i4 , ./4 /mss T6t i P S � � C Address
Notary as to Owner and/or Condo Presiden Date
My Commission Exp}Fle$ Iiil llllll llllllUlll7llllilllllNlllllllj(
. p 1PNV P U B Colleen A. Murton ZZ
'E '° ' A ''' Notary Public, State of Florida { '
e.
;ti `'• ` Commission No. CC 609929
.� ' '` i 'OF Fl.. 0% My Commission Exp. 12/25/2000: <
'< 1 - 800.3- NOTARY - Fla. Notary Service & Bonding Co. : 4
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FEES: PERMIT � RADON
Historically Designated: Yes No
Phone 73 (
Address
Address
Address
G ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
OI 1 t& n-, 1 r t ,1. d o E,.) ,-, s ' 4 : A 1
)
Estimated Cost (value) � ' `i () 0
1 -0 -
Signature of Contractor or Owner - Builder
otary as to Contractor o
My
>5 e , olleen A. Murton
Notary Public, State of Florida
e Commission No. CC 609929
' 'For A. ° My Commission Exp. 12/25/2000
1- 800 -3- NOTARY - Fla. Notary Soviet & Bonding Co. :
C.C.F. 6° NOTARY
APPROVED:
Zoning Building
Mechanical Plumbing
Master Permit #
10 a UJ eS r) 7 S74 f p7
£lectrical
7A /5 Oa
Date
Date
BOND a�
TOTAL DUE
Engineering