115 NE 94 St (20)/Tenant' NtediZ4- /2/46-44/6 r'
Owner's Address' \ 11 5 (/' e, F4 S j:
Contracting Co. j�G F
Notary as to Owner and/or Condo President Date
My Commission Expires:
Address
Contrac
Phone
My Commission Expi
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3 —6 —,4 Job Address / (15 t7. 'T4' Sr Tax Folio
Legal Description Historically Designated: Yes No
Master Permit # °1 q T 6
3r- 7 6 / o6
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one) : UILDING ECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION O G Co P; NGr 7't + - E $ g fll)(n 43(.4057 Dif! 11o6/A 54. /T. 1
X
Square Ft. Estimated Cost (value) 9 ! 300 4.49
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.)
i
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.
OWNERS API7l)AVIT: 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 w k stat
3 -G -0.2.09 9 /
Signature of owner and/or Condo President Date 14 e of Contractor or Owner- Builder Date
Date
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,r n co,a+risna:' ;:uaser
gt 'qi' -: CC786657
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OF FAO NOV.