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60 NE 99 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date w y Job Address GO Mt_ ( SL • Tax Folio Legal Description GA) Historically Designated: Yes No OOwner/Lessee / Tenant O- MI∎J1 - 2'wk4.tti Master Permit # Owner's Address © Mt_ �� `� Contracting Co. Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one • BUILD t ' ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION` u� s 1�11i 1 � � \ o `� A l C V�o l 1 L, O �- a �. W Q 9(l '3‘7,k `�1s z. rrit c:110.4v 0•44) Square Ft. Estimated Cost (value) 4 APPROVED: Zoning Mechanical 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 th ark stated. M all wry Signature of owner and/or Condo President Notary as to Owner and/or Condo President Date My Commission Expires: 4?4JQi (0O0O o FEES: PERMIT 1 0 RADON C.C.F. 3 Buil Date Notary as t• ' ontracto My Commission Expire Plumbing zi-g9 /7'/ Phon @�l e `1 Co ` 9 00 Address er- Builder Ay1A9 A tor or Owner- Builder ate 16a s Nloy1 O, PRY PU 6e, ANGELA NOTARY SEAL BER = l ~fit COMMISSION NUM r" t• Q CC786697 ; MY eo MISSION EXPIRES F OF FAO NOV, 96_2002 C NOTARY S — 0 0 BOND TOTAL DUE Electrical Structural Engineer ae