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893 NE 96 st (10)Date / Job Address dP/ J R Tax / .� E 4 1 Legal Description ` ©� , / 6Ik. Wit Owner / Lessee / Tenan4 f Ap4i ,____vp) Owner's Address ',/, �� 96 c >/i Contracting Co. i %7 Address Qualifier SS# - - State # Municipal 1 Competency # Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRIC L PLUMBI G MECHANICAL ROOFING PAVING PENCE SIGN WOR D SCRIPTION Squar Ft. 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 informati / is a�� urate and that all work will be done in compl'ance with all applicable laws regulating co; �Z;�n and zoning. Furthermore, I horize the a. nan-d contractor to do the work stated PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Estimated Cost(value) or Condo President Notary as to Owner a Y C ° 0tid6F4+e1stdenit'r SEAL . (% SCOTT W DAVIS My Commission Expire Z t7) r n 4 }`...... * COMMISSION NUMBER ., CC255237 -T- c, f V COMAY/SSION EXP. ** * * * * OF , . �, Nv :.s, a n9 FEES: PERMIT "Id Y.C RADON C.C.F. APPROVED: I r Signatu Date: Polio C/ 5206 ?2 Phone of Contractor or Owner- Builder 7 Notary as to v thi � fir• actor My Commission` trfOt 0: NOTARY Master Permit # Phone 75 /WY Ins.Co. SCOTT W DAVIS COMMISSION NUMBER CCw55237 MY COb':f SS171 EXP. 4P M. 211697 I TOTAL DUE 5 ` %I ** Fire Zoning Buildin Mechanical Plumbing Engineering Other Electrical