1154 NE 91 Terr (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1 ( 7 Ss Job Address /45 tiE 9 / Ze ff ax Folio
Legal Description Historically Designated: Yes No Q
/ Tenant Master Permit # 2) 3
Owner's Address ��`J z %/ 6-- 7- - Phone 7 ,34— z-l0
Contracting Co. / �� AJ C - Address
Qualifier 2 /I . /� ��6�'t 6)2 - SS# Phone T
State # 414 Municipal # Competency # Ins. Co.
Architect/Engineer --� Address
Bonding Company Address
Mortgagor Address
�n.essee
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING CHANICAIj ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 3 <-° 4 ' ) C# C 0 ' ` 7 'K (O (<
t S JJ G,U�,E r rail
Square Ft. Estimated Cost (value)
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 -n d contractor to do the work stated.
K
Si and/or Condo President Date e, Date
No as to O er and/or Condo President
My Commission Expires: /7 V'f 7
APPROVED:
Zoning
Mechanical /1-
Date otary asto Co _ :. . • .a� - -: ' . -
My C d of X DIAL NOTARY SEAL
O
/1 SANDRA MONTIEL
z ,- T' r * M COMMISSION NUMBER
T .'P Q CC401261
}'r ^ Q MY COMMISSION , EXP.
(.‘ OF FJ AUG. 17
Si atur &f Contractor or Owner- Builder
`` Building
• A + IC'"
`•-1 ,; 4
l ( Plumbing
C.C.F. fl t / i` NOTARY TOTAL DUE
Electrical
N
Engineering