251 NE 98 St (14)<- 9h1 , 044uii Cr/4
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address Z 5 / 4)k-' c ' 18 . Tax Folio
Legal Description / ! �^ Historically Designated: Yes No
Owner/Lessee / Tenant /J�OCPrS 2 YJ el L J c9L95 . Master Permit # _
Owner's Address '2 P5 9=58 Phone ('os) 7.373 9680
Contracting Co Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one) B UILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION qQ £ ' Z • cf
Square Ft. Estimated Cost (value) /SO
FEES: PERMIT � V RADON
APPROVED:
Zoning
Mechanical
Building
C.C.F. ` (2 NOTARY
Electrical
Plumbing Structural Engineer
0 an
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all w, �' will be don m compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do th i ' y! ed.
Signature of owner and/or Condo President Date r ., : ture of ' • I : ctor or Owner - Builder
��2�J - .53 D
.gr;ni z•
Notary as to Owner and/or Condo President Date Notary : o Contrac
My Conunission Expires: My Commission Exp s: Gl At �TI1.tAR �r.Ii A
>; �'►fiYJ+wJ %I1� STAT
MYTr4t,�.6 CifVX1.MA
BOND
TOTAL DUE S
6// 9/00
6 ?'"
- ea v
Date