1200 NE 91 Terr (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date lP � Z l r Job Address ) 014 - 5D #'E I/ re rr Tax Folio
Legal Description Historically Designated: Yes No
Owner/l./ess nt .- PLL mmie (I V w c 1 Master Permit #
Owner's Address ) 2J c) N t 7r/ / e - Phone 7s - r - 4 /2 3 S
Contracting Co. b W—' Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle on : BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 61 I O 1 OLtA` 1.-S1 ^ 4fk it c4. 4P66 �t —
Square Ft.
(e
Estimated Cost (value)
/ OOJ
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 r nstruct •n and zoning. Furthermore, I authorize the above -named co .. ctor to do the work stated.
Si e t{i(e • " owner or Condo President Date Si a a tr ' Contrac or Owner- Builder
Notary as to Owner and/or Condo President Date Notary as t
My Co
My Comnussion Expires:
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON
C.C.F.
jiiFF1CIAL NOTARY SEAL
�. SAN[lRA M MONTIEL
* COMMIS;.. :ON NUMBER
CC401261
MY COMMISSION EXP.
F OF f\ AUG. 17.190E
NOTARY
Electrical
TOTAL DUE
Date
- `r'
f
Date
Plumbing Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
D a t e . 7 5 J o b A d d r e s s /7 Oc' X-1 E G(j S t 7i Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant A 1A1_ ti ,S I v v1 f`+. t C t, c� I � -L _ Master Permit #
Owner's Address 1 a-0 0 l G ( 1 i S r %
Contracting Co. (9C Address
Qualifier SS#
State # Municipal # Competency #
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION I t t ' l C \ A L — J J . 1 ) 2T 0 - c 1,? ,,1. 7 'd C r T o? f `i i i' r
4 \'y'ti"" 171 1
Square Ft.
Signature of owner and/or Condo President Date
g
FEES: PERMIT 3 7 RADON
APPROVED:
Zoning
Mechanical
C.C.F. 1.
0
Address
Notary as to Owner and/or Condo President Date Not
My Commission Expires: My C
Estimated Cost (value)
37q'6 - 7
Phone -
Phone
Ins. Co.
e 452
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 -mimed contractor to do the work stated.
I /
J/ •
• •1 . • • 111,4• -
n ( xj*fFPIAL NOTARY SEAL
O ei SANDRA M MONTIEL
k J * COMMISSION NUMBER
Q CC401261
r QUO MY COMMISSION EXP.
S OP F\- AUG. 17 1998
-
Electrical
of Contractor or Owner- Builder Date
ignatur
f i
` � r b ) 7 >5r;
i m-
'� 'fi s rr9 • LG" / ( -a
NOTARY TOTAL DUE L( 3.
Date
Plumbing Engineering