740 NE 96 St (9)Date
Job Address 7V4 9 ' C Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant (.
Owner's Address
Contracting Co.
Qualifier . 1
State #
70)4J 9
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
T /5frP. /1E7.
/%O Phone
Address
SS# ' . - / '� -
Master Permit Al /1 C . 9 e - 7 /
r,,
Phone 0 .-5 77
/ D 9c?/ Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
1?;--P1-1%) c
Square Ft Estimated Cost (value) ///7,77.2
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 a and that all wor '11 be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above-'. - . i . ntractor t• o the work stated.
"� COMMI ION 4 CC 550034
Signature of owner and/or Condo President Date S L ` c�Go ;8 ' �� ! � Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
, �0 J
q1
FEES: PERMIT 3e- RADON
C.C.F.
Notary as to `C` actor or Own.- Builder
My Commission Expires:
NOTARY BOND
TOTAL DUE
Date
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering_