215 NE 95 StPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date OZ— 23— 9 3 Job Address 2/, /LL-6 . gS S r Tax
Legal Description y /�
Master Permit # ✓'�/��7
Owner / Lessee /(Tenant)
Owner's Address 3 4- At
Contracting
Qualifier
State #
Square Ft. /D
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otary as to Owner and
My ommiss i
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APPROVED:
' 1+7/7/4
vtf. 9 Phone 757- 7153
Co. (4 ' i-FUArk efi9 )Address
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SS#
Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICALL RROOFING PAVING FENC
WORK DESCRIPTION S/Cr7✓ °— CoMP,1 i s n/4 (W)/ J
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 accirate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
autho ize.,,the above -named contractor to do the work stated.
Si
Da
Zonin
r and /or Condo President
FEES: PERMIT g Od RADON
or Condo President
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LOUTS F I'.3EL&CO
NOTARY PU2LIC STt . _ _. o LORID
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Buildin
Mechanical
COMit =CN E✓:.
C.C.P. NOTARY TOTAL DUE 3 � `� 0
Phone
Estimated Cost(value)# 40
Polio
Notary as to Contractor or
My Commissio E�Cpir
tee. 30, /V
ctor or Owner- Builder
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