1026 NE 91 Terr (10)Leal Description
Owner / Lessee / Tenant
Owner's Address
Contracting Co. te/A./'2, Address
Qu li£ier SS# °
State # Municipal # Competency # Ins0Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): WILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION & .) 05 d /2 k 1z
Square Ft. 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 WITEL YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMN ;NCEMENT) .
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, ROOPING 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.
j , -,
Sign = ur `o£
Da
My Commission Expires:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address /0,2 AC/E W le* Tax Folio J 3 -0S` 0 / `®O3/0
COR4F,
pE
and /or Condo President
Signature of Contractor or Owner-Builder
Date:
0 3/2 g
Notary as to Owner and /or Con.. President Notary as to Contractor or Owner-Builder
OSCAR A. OAIVQTTO
� ,r' . My Commission Expires:
'r ' . : r W COMMISSION 0 CC3395f2 EXPIRES
> ,•
�— January 4,1998
' ` BONDED TRRU TROY FAN 5SURRt:CE, GYC.
** * * * * * * * *
FEES: PERMIT IVI ,)/ RADON C.C.F. NOTARY TOTAL DUE
APPROVED: Fire Other
Zoning Buildin Electrical
Mechanical Plumbing Engineering
* *
Master Permit
Phone 3
Phone
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