352 NE 98 St (9)Date y Zo
Legal Description 4
Owner / Lessee / Tenant D n Y l C c/ a/ C Master Permit 4k JVA/ e
Owner's Address 3 _2 ?I ft Phone F 9 - 5--- /- 3 col
Qualifier 11 c /PP /
/'J `flrP�9/'^I � Address /27DS
Contracting Co.
SS# Phone r
State # Municipa # Competency # O /C Ins.Co. £Gc - /vrs ZV r
Architect/Engineer Address
v/
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION
/ice
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 construction and zoning. Furthermore, I
authorize the abo na d contractor to do the work stated.
--(
_,32AILIAj/ (14
Signature of owner and /or Condo President
Date: /.2/0?
�eQt ary s to Owne
My Commission Exp.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 1 j7' Tax Folio // 3 Z06 /3 5-69O f/
** * * * *
FEES: PERMIT 2/7 6
APPROVED:
« d— 5 q/ d ,/ /z )i 1 /
•
EPHINE CHURCH
vtra Pubfk, Stattot itonda
No. CC197545
RADON
r
* * * *
C.C.F.
Fire
NOTARY - TOTAL DUDE 00
Other
Electrical
Plumbing Engineering___
Mechanical
/ 00/ - : e . � w 4 .
22/ of Contractor Owner - Builder
00
Notary as to Contractor or Owner- Builder
,4 i
N0 8T SII a RY u�. BONDED BY S
c251Cf�f'flx EExpires:
I. 1.1 NO CC 1773
ov c\ * *