833 NE 99 St (13)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Z 5 Job Address ] ?3 AU E ??:_ti r S Tax Folio
Legal Description /co C G- o - /Oar& Si Historically Designated: Yes No
n 1
lvl�aster Permit #
Phone 7-5—T— 37Y;7_
Contracting Co. Address
Owner's Address
SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer tJ A Address
Bonding Company NA Address
Qualifier
f3 3 10 E - s - ( -
Mortgagor Co, 4 r c Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION (,
Square Ft. 54 "` 9 07,0-
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. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or C
Notary as to Owner and/or CondoPresident Date
My Commission Expires:
FEES: PERMIT
D ate
ci'LCe. a 40rY s r
Estimated Cost (value) 7 an � —
dent Signature of Contractor or Owner- Builder Date
Notary as to Contractor or Owner- Builder Date
My Commission Expires:
,OPtZY p 4 OFFICIAL NOTARY SEAL
O SCOTT W DAVIS
• g » COMMISSION NUMBER
CC255237
� � MY COMMISSION EXP.
OF Fti� JAN. 26 1997
APPROVED:
Zoning Buil
Mechanical Plumbing
TO NOTARY
Electrical
SO
TOTAL DUE 4ir
Engineering
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P 0 U N DARY SURVEY MEETS THE MINIMUM
SURVEYS AS SET FORTH BY THE FLORIDA BOARD OF LAND SURVEYORS IN
DA IIISTRATTVE CODE. PURSUANT TO SECTION 472.027, FLORIDA STATUTES.
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1. PLAT BEARING BASE, THE UNE MARKED {
2. LEGAL DESCRIPTION PROVIDED BY CUENT.
3. THE LANDS SHOWN HEREON WERE NOT A
ENCUMBRANCES NOT SHOWN ON THE PLA
4. UNDERGROUND PORTIONS OF FOOTINGS,
' NOT LDCATED.
5.1 ELEVATIONS ARE BASED UPON NATIONAL c
6. FENCE T1 ES ARE TO THE CENTERLINE OF
7. WALL TIES ARE TO THE FACE OF THE WAI
8. IN SOME INSTANCES, GRAPHIC REPRESENT
ILLUSTRATE RELATIONSHIPS BETWEEN PHY`
DIMENSIONS SHOWN SHALL CONTROL THE
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