28 NE 98 St (11)Date
/ Tenant l ,f
er's Address
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one):
WORK DESCRIPTION
Notary as to Owner and/ Condo President
My Commission E • it
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address /^) q u Tax Folio
'ption Historically Designated: Yes No
Contracting Co. D
MEZIEME
s
Municipal #
J OSTa.0 tu"�e(1 0
ovc,,/da
Signature of owner and/or ondo President Date
Address
X�N J SS# Phone 3 DS - 7J ' -11z6
Competency # 1 U S J
Address
Address
Address
Square Ft. ` ` Estimated Cost (value)
FEES: PERMIT 0 RADON C.C.F. / 2 NOTARY
Master Permit # 7 � �� / S t)
Phone Sos- /61-
Ins. Co.
ILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
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.
Signature of Contract 3r or Gwn-'a:ui •e
BERN D -PEST
a a
Zfa
■■• •
.�
Notary as to Contractor or Owner- Builder
My Co u • Expires:
•
•
s� • w;r; ° AVILA
k6TAfi'= +7.G`i,?,,;i.:i:'3NiF CC813613
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STATE OF F F ^Pt a g' MAR 01, 2003
ff oatue f
BONDEO TriROUGH
AIW A` ,1 E NOTARY
Date
Date
BOND
gB
TOTAL
APPROVED: r
Zoning Building t G f de Electrical
Mechanical Plumbing Engineering