841 NE 98 St (13)Dated/ 0/ n / Job Address
otary as to Owner and /o
My Commission Expires:
** *
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
State # Municipal #
Architect /Engineer
Bonding Company
Mortgagor
FEES: PERMIT / 11 a >D RADON
Pi/ 4/E 9� .
Legal Description
Owner / Lessee (nan) �C�/y7 A 4 J g )
Owner's Address 3 I I ) /V E 1 ��
Contracting Co.
Qualifier ( v ,
L � 1 Gn�/,be�j ssa
ee 1 d `t'YG� n Cl
Permit Type(circle one): BUILDING ELECTRICAL PLUMnimi TIgcHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION � ! 11- �)` I701l se n o" /Q0oF
vd r vv4,• w1 // s PoaKA
Square Ft. Estimated Cost(value) /. / �I),/2
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 con truction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
720/72e/A
Signatu of and /or Condo President S gnature of Contractor or Omer- Builder
11 4 9 I G I *) Dat e r ., /
44311 �=FAL
VEDA S RUSSO
NOTARY PUBLIC STATF. OF FFLQR(DA
C�li \ 1'1'`+IC�I`r` NO. ty 1Q' 7
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f Phone
Competency # � Ins.Co. /VOW')
C.C.F. `o N
Mechanical Plume
2/D
dr
Tax Folio
Master Permit #
Phone
Add , J ,/ v (7 ■��
yC - ��c�cJ vim/ • G' � //
otar as to Contractor or Owner- Builder
My
o S4 ouramma4RQARY SEAL
O ei SANDRA M MONTIEL
2 �� r tl * COMMISSION NUMBER
* J O
e p * * **
'•,,w -COMMISSION
e Q. MY OF ON .EXP.
OF F\.O AUG. 17 1998
NOTARY .. TOTAL DUE f ' s 0
Other
Electrical
Engineering