895 NE 98 St (13).+ T
Date �'' 4 Job Address �l� tom- l ?5\ Tax Folio
Legal Description
Owner / Lessee / Tenant \" Master Permit #
Owner's Address
Contracting Co. % _ c c--v � _ Address N(2 C 4 \0 ---t-:-
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Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost(value) a --
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.
Signal re d1 owner and /or Comp President Signature of Contractor or Owner- Builder
Date:
761
Notary as to Owr
My Commission E
** *
APPROVED:
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
f. p ands n B. Ri p
1 COMMISSION NUMBER
��r � a CC360191
' MY COMMISSION EXP.
-- O F F � � q, MLNi. 28,1998 * *
C.C.P.
FEES: PERMIT 3 7 (1 a RADON
Fire
Buildin
w,c, 7j
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * **
NOTARY
Other
Electrical
Mechanical Plumbing Engineering
Phone
TOTAL DUE 114t4161
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1774 W. Flagler Street
MIAMI 3S. FLORIDA. ^ ` ` • ; .:
Telephones: 9-3508 82 -0027
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1 HEREBY CERT( that the attached sketch represents
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There are no encroatr ts .essegt a. show
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Telephones: 9-3508 82 -0027
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to the best of my knowledyetand belief.
There are no encroatr ts .essegt a. show
REGISTERED LAITCF BUR\iEYOR lif -T /'
STATE OF FLORIDA
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