262 NE 98 St (14)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE _ „.. .
10050 N.E. Ind Avenue • Miami Shores, Florida 33138 • Phone: 305- 795 -2204 • Fax: 305- 756-8972: l `'
�7
Date Job Ad v0 �� ge S Tax Folio i (I / r�
Legal Description Historically Designated: Yes
Owner /Lessee/Tenet t-e0 N
Owner's Address /Ji ` 6 57.12
v Contracting Co. Address
X 3oRK DESCRIPTION:
Qualifier SS# Phone
State # Municipal #
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one):
Square Ft. �� ated Cost (value)
VU
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 ANY 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 all disciplines.
OWNERS AFFIDAVIT: 1 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
FEES: PERMIT ORADON
APPROVED:
pc( 00
WOO I-)
Mechanical Plumbin
ELECTRICAL PLUMBING MECHANICAL ROOFING
Date
Master Permit #
My Commission Expires
Pho\ 30C 7847 CO 7 `s'
Competency # Ins. Co.
Signature of Contractor or Owner Builder Date
Notary a to Owner and/or Condo President / Date Notary as to Contractor or Owner Builder Date
My Co ssion Expires
C.C.F NOTARY w BOND
TOTAL DUE 635 ' 00
Zoning CJ�% b uilding . r Electrical
Structural Engineer