910 NE 99 StDate A,-c5- 5 Job Address 9/0 /U£ 5- 7 1 "
Legal Description LJ-i
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
/L 41..oU6, go S Lc "e 5 , >� /UJ 3
Owner / Iressee / Tti aza. Nu i A- 4
Owner's Address 1-91 �� S� Phone 7
Contracting Co. EC V)L f /wL Address S w 71 'e.v„D- cf t,
Qualifier - \ GA.✓[ 1 <- Ivy^'`' Phone y7V— 2.L.L' .-
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address "'----
Bonding Company Address
_ Mortgagor Address
Permit Type(circle one : :UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft.
5 6
Signature of owner and /or Condo President Signat
Date: Date:
Notary as to Owner and /or Condo President
My Commission Expires:
FEES: PERMIT / NJ ` L2 RADON
APPROVED: Fire
Zoning Building
Estimated Cost(value)
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.
** * * * * * * * * * * * * * * * **
C.C.F. //5 - D
� y �( Other
1 4 % 1 Electrical
Mechanical Plumbing Engineering
Tax Folio // (9°24 / Y 34(
41/ ,,
N•f ary s to
My Comnissio
-e4
Master Permit #95
tractor or Owner- Builder
• rk000 2/1
,Notary Public. State of Florida
� My Commission Exp. April 30. 1996
tiho A No. CC197545
NOTARY � ® D TOTAL DUE /t30/