1297 NE 100 St (9)Date /' - /T 91 SJob Address /9 7 / / d d S l Tax Folio) / A-215
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Legal Description E " 9 / /4`o� -� oi/
/ Lessee / Tenant Giy/v ,5 4',4- 19, --731 Master Permit 4 W
Owner's Address A. 1 i /U a S 7 - Phone 771P e-
Contracting Co . 04
Qualifier SS# -
APPROVED:
Zonin
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Address
Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICCAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION as:/// " `/GM - 6 2
Square Pt. 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
auth•iiize e above-named contractor to do the work stated.
A I
S ` 1 atur�e owner and /or Condo President Signature of Contractor or Owner- Builder
D e :9 /�l%� Date:
e edifhi;if ate(/ ry to Owner and /or Condo President Notary as to Contractor or Owner- Builder
ommission Expires: My Commission Expires:
** * * * * * * * * * * * * * * * **
FEES: PERMIT , 2 2 Z 4 RADON C.C.F. NOTARY b P» TOTAL DUE 1/g, 9I
Fire Other
Electrical
Mechanical Plumbing_ Engineering