273 NE 98 St (6)Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
90 Job Address 0Z 7 j 9g m Tax Folio
Legal Description CAR 7170:___ Historically Designated: Yes
Owner/Lessee / Tenant / .S / Master Permit #
4707
Owner's Address 9 /vL 9 g' k/? / Sk/9- -9hone (' 7---4/ 3
Contracting Co. OW ( =te Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL / PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /� lit/%'// /� / I e/7 - /e/'f /7 /.Sh, //I, e l-S
Square Ft. 0Z 70 0 5, Estimated Cost (value) (O, 7 )
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.
( 72.4 ` /41'9/p. cd n /zVq?
Signaturti 9
o f owner and/or Condo President a e Signature Contractor or Owner- Builder Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
Iff otary as to Contractor or Owner - Builder
My Commission Expires: -
Y (,. ;,:v,i,..:.v
• 6 ._
(1 n 'r
No
Date
FEES: PERMIT 4C RADON C.C.F. .2-0 NOTARY , BOO BOND —�
TOTAL DU( 9 i, 35
APPROVED:
Zoning Building 1 6 Electrical
Mechanical Plumbing Engineering