336 NE 98 St (8)a
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 3 9�.5/ Tax Folio
Legal Description 4 75 25 Historically Designated: Yes No��—
Owner/Lessee / Tenant / S /� ��OT Master Permit # 41
Owner's Address -g �1 �� / Phone 7V
Contracting Co. 14 / ,,,i f� 4 Address G 7: .0.`"a
Qualifier � rl /E / �/ /'z- SS#
State # Municipal # Competency # �..5 Co. /c,,r9,4 tJs/
Architect/Enginecr Address
Bonding Company Address
Mortgagor Address
Permit Type (ciircle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
� / /. �/ , .mod �7/G&�.y
WORK DESCRIPTION
Square Ft. ®96
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 reg}i3ating construction and zoning. Furthermore, I authorize the above -named contracto • • • e work stated
r
Signature of owner and/or Condo f 7 sident Date
Notary as to Owner and/or Condo President Date
My Commission Expires: (/
FEES: PERMIT 4 v • RADON C.C.F. / • g NOTARY r BOND 3 0
TOTAL DUE 3 yk, V7
APPROVED:
Zoning Building
Mechanical _ Plumbing
Estimated Cost (value) '$ 7 c 7
Phone
:r eof Contractor or Own- 411 u �•��
Notary as to Contractor or Owner - Builder
My Commission Expires:
Electrical
Engineering
Date
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