777 NE 98 St (4)A
Date h i - / - 9 t i Job Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Legal Description /,O •k- 3 13t_ k 7) I^n I A vo
Owner / I,eesiate. / - Tefka , at (a,1 M . M . ? 'IA 11. L. ) f S Mas ter Permi t # ."6
Owner's Address-} m C Phone 1 3 4 / 8. 1 1
Contracting Co. ( ow A j p . Address
WORK DESCRIPTION k)o o b 7v Sr
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * *
FEES: PERMIT , C' RADON C.C.F.
APPROVED: Fire
T 1 J\ l i Sr- Tax Folio 11 32 lit 2113"0
Qualifier SS# - - Phone
State /fr Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE .IGN
Address
Square Ft. Estimated Cost(value) / 2 .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.
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. thermore, I
authorize the above -named contractor to do the work stated.
Signature of Gon r -or Own - Builder
Date:
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W1ier--Bui lder
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EXAMMISAISSION EXPIRES
?�:ay 21, 1994
Y PUBLIC UNDERWRITERS
NOTARY TOTAL DUE - 3a4 -
Other
Zoning Building ' ` J7 1 ' i ec t r i ca 1
Mechanical Plumbing Engineering
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