1089 NE 91 Terr (8)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address /Q r tfrie- 5( 1? vL Tax Folio
F
L.gal Description Historically Designated: Yes No
'' Owner/Lessee / Tenant // // //tt MO 0 A k s Master Permit # V li 2
Owner's Add./0 a', /1C ?I --- r Y/ A e Phone 737 b
Contractin Co. sc/ 7 Po 0 rJ --(--&—)( Address /1C h C / kr/ S
Qualifier ..1 1-1.J f f e= SS ( SS# •. 2 /Phone ''r 9 `k-c( 0 00
State # d0 1 I* Municipal # Ins. Co. &IA r Z( 1- 6 14 - ) r)
Architect/Engineer
=fig Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL
WORK DESCRIPTION f/ 1 ,0 / 41 Ye e/ r l /,rte$ 7Q A e
Square Ft. Estimated Cost (value) c: 0 c
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate an
laws regulating construction and zonin • Furthermore, I authorize the above -n
Signature oho
N, any as to
Commis
or Condo President
AP
4 er_and/pr 1? sident
NOTARY PUBLIC, STATE OF FLORIDA
11y Commissioi Expiras May 24, 1999
Commission " CC 467719
d
APPROVED:
Zoning Building
Mechanical Plumbing
if)
Competency #
Address
Address
LUMBING2MECHANICAL ROOFING PAVING FENCE SIGN
Sign - Builder
Not
My
1
to Co tr
ssion Expir
FEES: PERMIT )/ ' (1 RADON C.C.F. 1, 2 NOTARY
rk > .11 be done in compliance with all applicable
to do the work stated.
Electrical
F
d
d r, Date
NOTARY PUBLIC
, �TA7E OF FLORIDA RFLORIDA My Commission
Expires May 24, 1999
✓__ _
Commission # CC 467719
:r i ,
BOND
TOTAL DUE /C —
Engineering