833 NE 99 StDate It��9 Job Address gi2 72f l7 (5"
Legal Description 44-
[7
Lessee / Tenant Ann 4 low
Owner's Address b • I c l � �. Phone
Contracting Co.
_d___t/
Qualifier
State #
Architect /Enginef
Bonding Company
Mortgagor
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Permit Type(circ
WORK DESCRIPTI
Signature of owner and /or Condo President
Date:
Address
SS# - Phone
o
w
N
etency #
Tax Folio // .104( o/47
Address
Master Permit # 5.5
7S� -S - 2S
Ins.Co.
Address
Address
PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost(value) K � cp,.
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 the work state
Notary as to Owner and /or Condo President Notary as or er- Builder
My Commission Expires: My Commission U r A JgLIC, STATE OF FLORIDA.
MY COMMISSION EXPIRES: April 16, 1995.
BONDED TIIRU NOTARY PUBLIC UNDERWRITERS.
** * * * * * * * * * * * * *
* * **
4
FEES: PERMIT ,J 2 5V RADON C.C.P. ,S NOTARY TOTAL DUE, 9 4 04 '
APPROVED: Fire Other
Zoning Buildin 4 �" Electrical
Engineering
Mechanical Plumbing