1089 NE 91 Terr (7)Date 7 30! Job Address /OF 7 / �V� T`-f7 Tax Folio
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Legal Description U.�a� -ed S�P 9 �� l 2 S17 1 Historically Designated: Yes No t.—"�s
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Owner/ .ssee / Tenant 6 V i 5 0 6/14 u h(A / / O rR it- S Master Permit #
Owner's Address /O? � G il 7
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Contracting Co. 9 w C' Y
Qualifier
State #
Square Ft / (620 3 t
Address
SS#
Municipal # _ _ Competency #
Architect/Engineer _ Address
Bonding Company Address
Mortgagor Z. rL sLl2 ve-e liTi L
// -3lO - oO /- WOO
Phone l 3 o f 7S l — G a
Address 6 .?2- T
Phone
rc (I
Ins. Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION P t Y I Ci L 5 �' C P' f e U.) Wi `k To kJ k
Estimated Cost (value) 20
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 authorize the above -named contractor to do the work stated.
Ad-ret:‘ y _s'
Date
Sienature of owner and/or Condo President Date S gnature of Contractor or Owner - Builder
4 f 2. -sa9,- o
/•
OtaN as to O RI _d i 'j - l� �k e� *P Dat N as to Contractor or Owner - Builder Date
My Commission xpiaiTZIY ST,n, `I C7 7.7.;321:3A My Conunission Expires:
1;1\ :ccilzao
FEES: PERMIT RADON C.C.F. A c 113 NOTARY BOND
TOTAL DUE ■ ¶ Q
APPROVED:
Zoning tail
� '\ ` c Electrical
Mecharical Plumbing Engineering