1099 NE 91 Terr (6)Date
Legal Description Historically Designated: Yes
/Tenant N n 1< € S Master Permit # Z1(7 Gg
Phone ( 7 " ( q q
Contracting Co. Pi - � IC) p n FJ N v+_� Address P - 0 .
SS# Phone D L t O OS
Owner's Address 1 O ° 1 vJ •
Qualifier 0 ofZQ AA) C e
State # CA <. C) / 3 a k4 Municipal # Competency # Ins. Co. G
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMB ‘G MECHA AL FING PAVING FENCE SIGN
WORK DESCRIPTION /VC, tr7-irf?."✓ el, .4 "‘.5.-..r_ t� , g -- r4Lt
Square Ft. Estimated Cost (value C'
4 0
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.
Signature of owner and/or Condo President
Notary as to °Wil - and C 'rdik t
My Commission Expires: 8 -\
FEES: PERMIT ( O / RADON
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
, ,
Job Address ' d CC,, l c 1 �' E• 1 1 l Tax Folio
C.C.F.
traXgr.Q,wner- Builder Date
My Comm Exp. 5/26/200). p ,
Bondel By Service 0CC650501� t1,, `� \1
Notary as to Contractor or i der Date
My Commission Expires:
TOTAL DUE 3 2 a
,PPRO VED:
ming
xhanical " 0 ��'�7 Plumbing Engineering
Building
Electrical