760 NE 96 St (6)t.•
X75/,30
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address / )60 . ` ' c(O 4 ' Tax Fol io ll 3266'" 6/4 - 208.0
Legal Description
Owner/ Lessee / Tenant �A
Owner's Address �6 o 7(. E. q&2 AC . Phone ?S/'' 703 7
Contracting Co
Qualifier
(24
State i rOOOO73 "unicipal
WORK DESCRIPTION
FEES P
:.; AEPRO
Zoning'' = --
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Competency ?k = ns.Co.
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Signature o$ owner and /or Condo Prq
Date . f/ , i �
of ray as to Owner and /or Condo President
My Comraiss
,‘p,11 Ue OFFICIAL NO !AR' SEAL
** * r * ? Q * CC714I91 *
9r � MY COMMISSION i F02ES
0 !' SARINA M �IIPS�,H
0 COMMIS:310N UMBER
*
Address
Notary a
My Commi
* * *
A
Master Permit it c
ifrht)
Phone
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): 3UILDING C ECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE S
Square Ft. Estimated Cost(value)
`ARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
30 MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INT:
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y(
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above,
on the attached addendum (if applicable). I certify that all work will be performed to meet
standards of all laws regulating construction in this jurisdiction. I understand that sepal
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the
be done in compliance with all applicable
authorize the above named contractor to do
vt a
foregoing information is accurate and that all work 1
laws regulating construction and zoning. Purthermor(
the work stated. 6/77 _t om C v
Signature of Contractor or Owner- Builder
Date:
1
W '
t raGet'o!IIrL ea a r
g itNA M 1•I'RSCH
COMMI .SIGN NUMBER
Q CC714091
�! • MY COMMISSION XP!PES
0 f\. Mlig. 1 2402
C.C.P. NOTARY TOTAL DUE
Fire Other
Building Electrica
Plumbing
Builder
Engineering