117 NE 98 St (9)i.
Date '� V C Address \\1 Tax Folio
Legal Description orically Designated: Yes No
Owner / Tenan 1 , , 1, 11. ) ,k m�t Master Permit # y6� ��
Owner's Address 1 FT " . Phone 20 c ' 7 C->ss
Contracting Co. Addr
Qualifier
W ( K� iVC SS# 3 Sa
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 'CAc 1 o (per )
Square 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 ate 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.
Signature of owner and/or Condo President to Signature of Contractor or Owner - Builder Date
,/ v
Notary as to Owner . Condo President Date Notary as to Contractor or Owner - Builder Date
My Commission Expires:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Estimated Cost (value) ,
My Commission Expires:
C.C.F. r `' 0 NOTARY V ✓ BOND
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APPROVED: TOTAL DUE S J `
Zoning Building Of 1 /6 0 Electrical
Mechanical Plumbing Structural Engineer
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