833 NE 96 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date f g 3 3 '-1 r- clb 51
—: Tax /3 - f� Job Address Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant
Owner's Address
Contracting Co.
ale
Qualifier l ,°' iQ #9-"
State #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle One): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING A FENC
WORK DESCRIPTION L--te _ 04.6 ��tiy�� ,
ext
Square Ft. Estimated Cost (value) S U "
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 AFFIDAVI
laws regulating-con
. Ice
n
Condo Preside
fi otary as to Owner and/or Condo Prident
My Commission Expires:
NOTARY PUBLIC - STATE OF FLORIDA
ARLENE
COMMISSION 11 CC772
EXPIRES 9/2002
BONDED THRU ASA 1 ,rlOTARY%
FEES: PERMIT RADON
APPROVED:
Zoning Building
Mechanical
IT 3 3 .tie 9-t
/ , 7' ( 7e
- Jetove,e '<7
7
Date
(C '7
Date
ss# .
Municipal # s 2 3 / - 3 Competency # // 3 3 '2—
Address
Address
Address
1'hat . 1 the foregoing information is accurate and that all work will be done in compliance with all applicable
Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contrac or o Owner- Builder /
rciN
Master Permit #
Phone
Address /6 /L
C.C.F. ' 60 NOTARY
NOTARY PUBLIC - STATE OF FLORIDA
ARLENE WEAVERUNG
COMMISSION # CC772034
EXPIRES 9V20/2002
BONDED THRU ASA 14 308-NOTARY'
Electrical
No
.0 /3 /7 -V'
Phone 9 ¥7
Ins. Co. t$ !r—
Notary as to Contractor or Owner - Build
My Commission Expires:
BOND
TOTAL DUE 1 /
2 c
Date
/e. D to
6 L ,
Plumbing Engineering