873 NE 96 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address '7 A /,9 5 ' Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / TenanJa,N/ c / '�` ��Os ^�� C �/yi t.f4 / Master Permit # i ;2_5*
Owner's Address 8773 Air
Contracting Co.
Qualifier
State #4",-0 e) 70
OA/
Municipal # Competency #
Architect/Engineer
Bonding Company Address
Square Ft. Estimated Cost (value)
W AY Phone /
Address ..Cx. . ( Ahtd /S
SS# -
Address
Signature
FEES: PERMIT re e "O RADON C.C.F. ' 00 NOTARY
Ins. Co.
Mortgagor Address
Permit Type (circle one): BUILDING PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 15
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 co tractor to do the work stated.
BOND
Date
6
TOTAL DUE �b■ 4
APPROVED: ��
Zoning Building Electrical � ' 6` '
Mechanical Plumbing Engineering