1084 NE 91 Terr (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date '^ V ` / C / Job Address / (� f / / Tax Folio
Legal Description Historically Designated: Yes No
� _ j ,%�.e� Master Permit # �� 5
/ Tenant �.�� P ��/
Owner's Address Phone
Contracting Co. Q /r' Address
Qualifier SS#
Competency #
Address
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT (' RADON
C.C.F. (t�
Phone
Square Ft Estimated Cost (value) G
d
Ins. Co.
State # Municipal #
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BU I '1 ING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WO a .. 6 �� C. Vl� a g 4C;7_,/./ /
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO ''1 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.
otary as to Contra or or Ownef:=Bilitder .
My Commission Expilrr ;.'S ;`
Date _ j
1 C° C
Date
NOTARY BOND
TOTAL DUES:
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering