725 NE 96 St (11)Signatur
PERMIT APPLICATION FOR MIAMI SH(
• Job Address _25/1/96 Tax Folio
WORK DESCRIP'T'ION / 163M92
Square Ft. Estimated Cost (value)
6- 9 -Y,6_
of owner and/or Condo President Date
Notary as to Owner and/or Condo President
My Commission Expires:
IAL NOTAR S
CIRA M AVILES
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC458775
MY COMMISSION EXP. MAY 3,1999
FEES: PERMIT '�j ®. c' 0 RADON
APPROVED:
Zoning
Mechanical
atr
C.C.F. /• O 0
pp I
Building %A `m(' ?k
NOTARY
Electrical
Date
Legal Description Historically Designated: Benjami
Owner/Lessee / Tenant / �ed IV
Owner's Address 6 / Phone
J� 6295 �' -___; � v✓
Contracting Co. . Xd �,._/./i;i - 0770",•• '1 A17 Address i ,��
Qualifi er 1 A ) '/ /�d �3 711 ' i.3a VA ►/ 03
State # ,/7 % d.5 Municipal # ///0702 Competency # `��� " dCf 417 /11,.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Master Permit #
Phone
Ins. Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
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 c s struction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
• 1
Signature ofContractor or Owner- Builder
Notary as to Contractor or 0 uilder
My Commission Expire •
j \_)(7(7*: .CC i
_MELiNA CAMPOS-GARCIA
COMMISSIOP! Y G 462896
J(PIRES: 1; ;ay '1, 1999
r!.,id,;a Tln Notary Nigh Underwrllera
TOTAL
Plumbing Engineering
D.te