1195 NE 98 St (6)Date S Job Address 05 ,{/ 957
Legal Description
Owner / Lessee / Tenant A s fee/I/Ay-tip(
Master Permit # s 'S!7 I5a
Owner's Address /1f5
/14e- fD Sf Phone
Contracting Co I7A rgL�I 1 cos onfrAco'A' flO 44 400‘ 532
Qualifier F 1603
FIN r of owne and
Sig
Date:
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AT,. 11 /AAA
Notary as to Owr r and
My Commission Expires:
FEES: PERMIT
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
or Condo President
-/
% / mine CIAL NOTAR - S
N B
NOTARY Con • s ATE FLORIDA
N ' B
COMMISSION NO. CC179997
MY COMMISSION EXP. FEB. 12,1996
Tax Folio
SS# Phone 5,2 3®
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING
WORK DESCRIPTION l� I6i( £ 7 �Rfl ` '%
Square Ft. .?47/ ' Estimated Cost(value a 42f
My Commission Ex
Mechanical Plumbing
* * * * * * * * * * * * * *
FENCE SIGN
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY YOUR AY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO UR 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
auth or th e above-name con t t t do the work sta
ature of Co
e:
tor or Owner- Builder
Notary as t • Con �•. o rS m , Builder
PUBLIC STATE OF FLORIDA
;I1IISSION NO. CC1797
my x01!1 ?a,iiON EXP. FEB. 12,19%
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7 (r� RADON C.C.P. 1 L NOTARY TOTAL DUE
Other
Electrical
Engineering
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