30 NE 99 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3 Job Address 30/Ye / q 926 t Tax Folio // 5 ; ° /5 / I' '
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Legal DescriptionOC * '" R s11 O MS f.iccc. it Not am,j �}
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Owner / Lessee / TenantC�71 �vr}��N��l�� ��0. n
rl��a� ry Master Permit tP�
Owner's Address 3Oi'YE qq 9-6ZE6. ( Phone 30f.977,5 3g 99
Contracting Co. awNQ- Address
Qualifier SS# - - Phone
State #
Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor CAA-L. 6101001V& Address
Permit Type(circle one : BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION I *°•-0e rr
Square Ft. /� Estimated Cost(value)
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 co truction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * *
FEES: PERMIT 91 `
* *
N C.C.F.
APPROVED: Fire
Zoning Building
Mechanical Plumbing_
rtro rr Cb iflr
My Commission E
NOTARY 5' )
**
TOTAL DUE 5
Other
5) Electrical
Engineering
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