990 NE 99 St (11)Date Job Address 7 9ij 1/2. / Y _ Tax Folio // ff2 / // 5c'
Legal Description / / it -r re s y
Owner / Lessee / Tenants- �i�cn� �a ��� Master Permit #,lg l(G!/
Owner's Address 796 7 6 9% 6° ----(1---Y ' Phone 7.5 -02 S)F
Contracting Co. a
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 Ai, .� /,/.i.u0, 41 ,u,v2e- -e.0_
Square Ft. Estimated Cost(value r D,
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.
>`4- d"
Signature of owner an C�...:�. rel Signature of Contractor or Owner-Builder
; "; 4 B . JOSEPHINE CNIMM
It ' t Notary Public. SMt Willi
Camases ERLftglik
otar as to Owner anc AAARnifent Notary as to Contractor or Owner- Builder
y Commission Expires. My Commission Expires:
Date : hZlag /9a
FEES: PERMIT 37.. RADON C . C . F . ,S NOTARY %PT0 0 TOTAL DUE 4
APPROVED:
Zonin
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Address
Date:
* * * * * * * * * * **
Fire Other
Buildin., Z-2Q- Z Electrical
Mechanical Plumbing Engineering