933 NE 99 St (13)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Y/ -21 / 4 S Job Address 9 3 /u E 9 9 7=' sr. Tax Folio
Legal Description $ /..ivtiE m F
Owner/Lessee / Tenant f+ /2- c 4. S tq e, n, A-cv C own. G. ) Master Permit #
Owner's Address 1 o), �7 Q v cm:. Sr. , de) o r° ctie, c r y , F-i. Phone C 3 o x) -St 3 X. - ra 3 E 3
Contracting Co. Address
Qualifier 6-&-R -e. c.. T A- e_ K - m xi") SS# Phone 3 o S) Li 3 - 2 -(., 3 V 3
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address -- •
Bonding Company — Address
Mortgagor - N o r■i 6 - Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /2.6 - T, "✓Cr o " /2.0o / C w 1-f 7 71) V.-' rh rt' .4,...✓ -�
/bA
/ N b.F' CX r`Cv2,t o ✓�t, ` ° mob L 0 , -(Tn bo, o
Square Ft. i4 PP/+ -o)G , . 00 0 S C) � Estimated Cost (value) ,5" 00,
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.
SignaJue of owner an
A a L L' , '1- Y^ ( Notary as to Owner and/or Condo President Date
My Commission Expires:
•a" P OI, FRED M. STEIN
41.
v iz. COMMISSION # CC404221
` EXPIRES AUGUST 30, 1998
�w� ALAN INSURANCE SERVICE
1.800488
FEES: PERMIT -) ? RADON
ndo President Date
C.C.F.
Historically Designated: Yes No 1/
Signature of Contractor o
APPROVED:
Zoning Building
Mechanical Plumbing
er- Builder
Notary as to Contractor or Owner- Builder
My Commission Expires:
NOTARY
Electrical
37('K
/y
Date
o kjS V P Ge FRED M. STEIN
n COMMISSION 11 CC404221
, r EXPIRES AUGUST 30, 1998
It ALAN INSURANCE SERVICE
1.800.488.9040
TOTAL DUE
Date
o
Engineering