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801 NE 96 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date I? 4 i Job Address J i �� �(O S9 Tax Folio Legal Description Historically Designated: Yes No - Owner/Lessee / Tenant �J c i ph LouiSi Pr j Master Pernrit # /3 70 0 Owner's Address PA NE q to S Phone 3Cg "? S`?— (o 6;i Cam, Contracting Co. (j0 >ne s 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 � � ti i !� h a , ✓ Square Ft. Estimated Cost (value) ..5OC • 62) 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. FEES: PERMIT 4 RADON JSC(_s) 0/ 6 /7 62 rJ Signature of owner and/or Condo President Date Si: a of Contrac • Owner- Bude � - ?0_49... e e , Ir ?) /.2-y--- Notary as to Owner and/or Condo President Date •tary as t'J ontr�t� +'Owner- Builder Date My Commission Expires: My Commission moires : __ . - '' . 3N O. t. C.C.F. 4Z/ NOTARY 5 • BOND TOTAL DUE 4 7(.1 -7 : APPROVED: tt Zoning Buildin g (1%)? q Q� i ! J { Electrical Mechanical Plumbing Engineering