1241 NE 91 Terr (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address / 2 L// 17/ Q/ n Tax Folio qg /l
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant C 4/ /S - I.CJ/Z / 6 7 Master Permit #
Owner's Address / 2 L// 1 L 9/ 7- Phone 30.5- 7
Contracting Co. a/ ' E J /c->7 ( / N� di Address 9b S Ste/ s'6"
Qualifier C e7Z1l t? ;170 f SS#
Phone 30 S 2f/ ,S'OO
State #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION)( 4 - 7 X / r /1/ /1 , r [O A' � �P/ / %
Square Ft.
Municipal #
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 b done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contr. • to do - work stat
Signature of owner and/or Condo President Date Signs... e of Contract. •
I
/i -,,
otary as to • lac or or Owner- Builder Date
. My Commiss on Expires:
P
parr a o o o S . �.,, c r .:') %''\
Notary as to Owner and/or Condo President Date
My Commission Expires:
2/B
FEES: PERMIT ( 3 / 6 `°� RADON C.C.F.
480
# Ins. Co.
Estimated Cost (value) 3. 06
_ /; 1
Ft tiVA/L
NOTARY
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7 - ,
5 1 /0 S p
efP
BOND
//c -5:5
TOTAL DUE 7" `
APPROVED:
Zonin g Building i j vi/ em Electrical
Mechanical Plumbing Engineering