1094 NE 91 Terr (7)w
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Qq rw a _ _ /,,41 I
Date / Zy / I Job Address` '.� '����""- Tax Folio
to i - NE 4 /r2?
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant Y ��2G4'�'7
Owner's Address ✓ i / () 9 y A/ q/ Mt
Contracting Co.X Address
Qualifier SS#
State # Municipal # Competency #
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one).
WORK DESCRIPTION ( � c i L' z{' a• 14,0, - C —dg ct /i ua2
cJ
Address
Master Permit #
Phoney (3�'.t '?rt 2. -
r , u'L
Square Ft. Estimated Cost (value,( 3 fS
•
ELECTRICAL PLUMBING MECHANICAL ROWING PAVING FENCE Sibri
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.
Signature of owner and/or Condo President Date
FEES: PERMIT
s o
RADON
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the wor
My Commissi n xPUICIAL NOTARYS
GLADYS J VILLAR
i IOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714:03
MY COMMISSION EXP. MAR. 1,2002
Notary as to Owner and/or Condo President Date Notary to Contractor or Owner- Builder Date
My Commission Expires:
C.C.F. / ° NOTARY BOND
V
TOTAL DUE , �
APPROVED:
Zoning Building * Electrical
C
Mechanical Plumbing Structural Engineer
Date /c2
"WORK DESCRIPTION
Job Address
Notary as to Owner and /or Condo President
My Commission Expires:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
09y IVF 9� �
Tax Fo
Legal Description /c 74 OZL4
ILIA # A.. °A AAA !_IA
Owner / Lessee / Tenant /�
Owner's Address / G 4 9� / 'GU 9 alAJ
Contracting Co
Qualifier SS# - -
State # Municipal #
Address
Competency #
Signature of owner and /or Condo President Signat
Date: Date:/
ot= y as to
My Commission
liof/ 2.2o
* * *
NOTARY 1 ,41416
Master Permit #350
Phone
Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
j e.//27 - , v fry Xhiecive,
Square Pt. Estimated Cost(value) ��& 2
Phone
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.
. 10SEPHtNI CMIIIEM
., it,„.„.
,,, i . `�' IM CC197595
4
TOTAL DUE 1725,07
**
FEES: PERMIT , ((7 C.C.F.
APPROVED: Fire
Zoning Building ( ; / ' Electrical
Mechanical Plumbing Engineering
Other