933 NE 99 St (7)5�.5
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address Q.3 27 G • Q9 b Tax Folio //— 3ZC4 a35
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant W 2 S lej LA/ »2v Master Permit #
Owner's Address 9 77 ELF &-
Contracting Co. i _ - _ _ - Address
Qualifier JiaQo
State # e X 00041 Municipal #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDIN ELECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
1
ture o • er and/or Condo
4 L. .
irotary as to • er and/or Con
My Commission Expires:
/- �
Square Ft. Estimated Cost (value) /G7/10
0
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 : •zoning. Furthermore, I authorize the above -named contractor to do the work stated.
nY P
xL
•
9,
OFFICIAL NOTARY SEAL
SARINA M HIRSCH
0 OMMIBSION NUMBER
MY CO
MAFI.
ON EXPIRES
1 2002
• O'
3 3/3r Phone
Competency #
Address
Address
Address
FEES: PERMIT j'S ' RADON C.C.F. 20 NOTARY
otary as to Contractor or Own -
My Commission Expires:
lS' /2a
Ins. Co.
SS# hone qe7Z "' /ICk
1zvNifa
•
OFFICIAL NOTARY SEAL
COMMISSION NUMBER
CC714091
MY CO MISSION EXPIRES
•
- 11 rA
Si
e of Contractor or
BOND G �1
TOTAL DUE
APPROVED:
Zoning Building Elect i -- r�
Mechanical Plumbing Structural Engineer