1099 NE 91 Terr (7)Permit Type (circle one):
FEES: PERMIT �O
• ,
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 1 91 11- 9 r-r Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant, t
/ J n -) C . rn r a Z r ( /; Master Permit #
Owner's Address �� Phone)( � rj • 5 • a 7 S 8
Contracting Co 25\0-Ni Address
Qualifier SS# -
o
State # Municipal # Competency # P
Architect/Engineer
Bonding Company
Mortgagor Address
Signature of owner and/or Condo President Date
RADON
Address
Address
AO
1-
o)
AO
4
•
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION J SS LI r-Q lam -Mr) f RP . G I' C D � Ej�� -ek / Or'
le-
Square Ft. Estimated Cost (value) i QQ 0. 0 (j
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 OF 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.
C.C.F.
40
i
. ture of C tractor
i "
Notary as to Owner and/or Condo President Date Notary a o Contractor or Owner- uilder
My Commission Expires:
My Commission Expir
Owner - Builder
2 -423 6 - 0 -
OFFICIAL NOT Y SEAL
GLADYSJ VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC7I4io3
MY COMMISSION Exp. MAR, i; oo2
NOTARY , BOND
L 0
TOTAL DUE �J
Dat
APPROVED:
Zoning Building ie Electrical
Mechanical Plumbing Structural Engineer
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date -- Job Address /099 kip 9! TI
Legal Description /.?
Owner / Lessee / Tenant 4 2 X S MA-a w- h71-
V I
Owner's Address 10q9 /J& c
/
Tax Folio / 3 Z j5 D/
Master Permit
Phone ?S - G y43
Contracting Co. Address
Qualifier 4//4//1./A SS# - - Phone
State 1fr Municipal 1U Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION G A (,J % / t(Co £ kT - 2l o fZ #0(,),S6= -f 0 c
Square Ft. Estimated Cost(value) 1 / 1 / Q'
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 a••ve -na e• •• stated.
/•' (%.• JOSEPHINE CHURCH
;Notary Public, State et Fbrkl•
30. IMM
Signatur P owner and o
Date://4 / y
' 'y as to Owner an
My Commission Expires:
** *
FEES: PERMIT —.4' 5 2
APPROVED:
riot type or stamp name of Notary Public
f d p g r e D
y� an nwn�ier A� uced:
DID rake an oath, or
DID NOT take an oath.
* * *
RADON C.C.F. is 'D NOTARY- TOTAL DUE'!S'
Mechanical
* * * * * * * * **
Plumbing,
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
Other
Electrical
Engineering