165 NE 98 St1 i� 5' Date c. J�Ier Job Address �L � Nc ��' � (�`� r Tax ?o1(la
Legal Description
Owner / Lessee / Tenant t DA C -C( Jet= Master Permit ,p 9',00r2)
Owner's Address f (( f. it/E qk
∎c) Phone7S / �c k
/� 5°C � ,c/( D /
Contracting Co. �/ 1���� ��� ��<-� � Addres 1 '' �3�
ss ) / //) Phon // / 9C((X
r p
S —/" iDi �+uni� _gal ?� ' Competency ;p Ins.Co.
17/"\-1 l`
Notary as t
My Commissi
FEES: PERMI
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Zoning
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDIN ELECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIG:
WORK DESCRIPTION Q /a
Square Ft. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO D.
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEN:
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU:
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. I understand that separat
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 wil
be done in compliance with all applicable laws regulating construction - d z•ning ermore,
authorize the above -named contractor to do the work stated.
S onature of owner and/or Cond• 'resident
Date:
My Commis §on Expires:
it - / e ) - 700
Sigtfatur'e c,, ,,;„yoflt• h 0
Date:
j c fi iti4Owner-Builder l oper - Builder
No R�`!s ilder
* * * * * * * * * * * * * * * * * * *
C.C.F. , ® NOTARY TOTAL DUE 3S
Fire Other
Building Electrica
, .5•,.///
Mechan - ;a1 Plumbing Engineering