925 NE 98 St (11)Date `/=6 Job Address 12 s /obi S $ 3 J Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant
Owner's Address
WORK DESCRIPTION
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
72 A/4 9 13' 57—.
Contracting Co. ..<' // 7)s Cd / Z C • Address
Qualifier (7/5/ 1 ` 3 /s�7' S SS# �O> ec 2 as
2
State # Municipal # Competency # E - 2007 G Ins. Co. 2 2 7 E c) d
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. '3 / (j / 8 A 40 Estimated Cost (value) /000
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 regulat •n = o and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
tief
6" G/ /»f /2CC1/2 A3 /9 S c rt / / 9L
PthR `i "/� 4/
e of owner and/or Condo President Date
fi g. L.)7261--
Master Permit # Z 7 /) / 7
Phone 75 3 3 7
Si ure of Contractor or wner- Builder Date
otary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My.Cc niasie °"'"" " ".,,...., . My Commission Expires:
� r1 �°
FEES: PERMIT � • • RADON C.C.F. ✓ d NOTARY 3 • TOTAL DUE
Buildin
Electrical
Plumbing Engineering