73 NE 99 St (6)l PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / a - 9 Job Address 73 N E 9 % 1'. Tax Folio
Legal Description �/� Historically Designated: Yes No
Owner/Lessee / Tenant &/ r d ` ant WQ /- nr/ f eK) Master Permit # (---/S-q47 Owner's Address ?9 ci9y es Phone 30S — 7 5
Contracting Co. ()L-t' h P r^ Address
Qualifier SS#
State # Municipal # Competency # Co. _
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
My Commission Expires:
APPROVED:
Zoning
Mechanical
FEES: PERMIT 3 RADON
Permit Type (circle on BUILDING `ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / Gt i yr S) d C Q ( /200 € ) 12 's G /K:eetdc / pct ��/Ik
"a,,�
Y Y✓/ cdo G[) s 'F e Ll t m n cam /
Square t. Estimated Cost (value) � o .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 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.
OWNERS 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 owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
Signature o ntract r or Owner- Builder
Notary as to Con
My Co
x Pe
C.C.F. 60 NOTARY
or or Owner- Builder
e--
BOND
• OFFICIAL NOTARY SEAL
� RgAAI
y�� Y A �
' Q S cc(/a► A7
r O MY CO% SSION EXPIRES
l - O P DEC. 17,2002
Date
/p2 - d ? -9
TOTAL DUE �.S 6
Building '��/ Electrical
Plumbing Structural Engineer