950 NE 96 St (3)Dap‘ Job A dress
Legal:'/bescriptioft
'ERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Tax Folio/
6 6 /t, 6
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Master Permit #P
Owner / Lessee / Tenant
Owner's Address _ ` Phone j
Contracting Co. / ' Address
Qualifier SS# - - Phone
State li Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDIN LECTR AL PLUMBING MECHAN CAL ROOF NG PAVI NG FENCE SIGN
WORK DESCRIPTION /////; ����� S� %c�� °1
Square Ft. Estimated Cost(value) /A5W
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 constructio and zoni g urthermore, I
authorize the above -named contractor to do the work stated. //
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
N. ary /as to C
M Commission
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FEES: PERMIT
526 RADON C.C.F. h ( NOTARY 5o0 TOTAL DUE i[ib ge
APPROVED: Fire Other
Zoning uildin:�`�� Electrical
Mechanical Plumbin: Y Engineering
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