1183 NE 99 St (11)ifX/D/
- 1111
1E
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address / 13 At • & , ?? Sr Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant W) L t_ i 6M y 1 E./v/ JE y Master Permit # 4/53 /i/
Owner's Address Phone){ 3057 7S ' — 3 i9 7
Contracting Co 6643 SE/4 Address / \
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one) BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENC SIGN
WORK DESCRIPTION' f1 G * ,4 G/4/* FE/t..' Fb,< Ti/ '3' k )/4 go. 2-#6- fi..AvtiF
O . . L. : E " ThLE E/1/C _ / C
-A L.c4F V / Z / s EEL . #E/ f T - 1 f8 ';• 47 S _ Opt/ & /o) er
o
Square Ft. Estimated Cost (value' 2.2. od , 0
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 perfonned 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 contractor to do the work stated.
Signature of owner and/or Condo President Date ignature of Co
- 77S
Notary as to Owner and/or Condo President Date Notary as
My Commission Expires:
Address
My Commi
t
ctor or Owner- Builder
LUCSTATE OF FLORIDA
• ISSION NO. CC714103
MY COMMIS¢ION EXP. MAR. 12002
g' /S/7"7
ate
00 Q
-/f -7/
Date
FEES: PERMIT RADON C.C.F. I A 6 NOTARY Y BOND
APPROVED: TOTAL DUE 1
Zoning Buil" ` Electrical
Mechanical Plumbing Structural Engineer