1208 NE 98 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE '
Date C / Job Address la o 2 ti (E q 8 Sr. Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant // 114 R 5 E PoN/9 11 U & Master Permit #
Owner's Address /c 0 6 C 1 v Phone 7S-6.- r v,z 7 9 R.
Contracting Co. Q a4 / V (- U �' 1 Address /// ol K / • �(7 / S (3N4 L, Rp
Qualifier /5 V
APPROVED:
Zoning
Mechanical
er and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
Building
SS# 3 ^ 699
State # Municipal # / Competency #
Architect/Engineer Address
Bonding Company Address _
Mortgagor Awe —
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION P/1sz SS U J E L. 14 /U ?Z //JT 4 7K77 R f c R l c
"
Electrical
Notary as to Contractor or Owner - Builder
My Commission Expires:
Square Ft. Estimated Cost (value) (7 1. c, O
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 construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
'LC
Signature of Contractor or Owner- Builder
LS 2 ?,>
Date
?M7
Date
FEES: PERMIT W. RADON C.C.F. • NOTARY ,5- BOND
TOTAL DUE. 4- 76z -16
Plumbing Engineering