40 NE 98 St (14)'t PERMIT APPLICATION FOR 'MIApI SHORES VILLAGE
Date I ica(01q
Legal Description
/ Tenant Euzftgele
40 NC cg s
OW Ng-
OW N212-.
Qualifier QVVNt
/ Lessee
Owner's Address
Contracting Co.
State #
Job Address
SS# -
Address
Municipal # Competency # Ins.Co.
4 0 VG q f;1 Tax Folio
Master Permit # 73 /7
Phone l ? 4 4 ( (,
4
Phone
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION CE: )CrE L (3
I WITINJ G c) loo USE
PA I INTING oF Root - To W 1 TE
Square Ft. Estimated Cost(value) Jj J O C%C'.
a 0
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 WI"' " "' "" "" 'ENDER nR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain
on the attached addendum (if applical /
standards of all laws regulating con
permits are required for ELECTRICAL,
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
autho the above -na ed contractor to do the work stated.
Sigaa ure
Date:
P. Lama_
er a or Condo Pres? dent
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * *
FEES: PERMIT k RADON C.C.F.
APPROVED: Fire
Zoning Buildin
_us
S IGNS, POOLS,_
Sign
Date:
tion as indicated above, and
ill be performed to meet the
I understand that separate
and MECHANICAL WORK.
or Owner - Builder
er- Builder
Nota kyra`it/ 0sI*.
My r r� -( , a rt 1g Nurr E
1. Q CC401261
''f "M cis COMMISSION .EXP.
* ti * OF F\. AUS. 17 11998
NOTARY TOTAL DUE
*
**
Other
Electrical
Mechanical Plumbing Engineering