803 NE 91 Terr (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date L k F 9 Job Address BO E 1 Tax Folio
Legal Description Historically Designated: Yes No ✓
Owner/Lessee / Tenant A► A ti ) CAV A NA) Q Master Permit # q t i �4
Owner's Address 9D3 N 4 t fi'e AtiL Phone
Contracting Co. G A\ Iml\ t1 Address - '7 ? NUJ 5.4 M f A, 331 Oa
�[ o
Qualifier 'tD U00 2‘/9O\ SS# Phone (50V) (39 -33110
State # Municipal # Competency # Ins. Co. 1
Architect/Engineel I Pt51)3P A01), ] )Q. . Address Z i ZS '�t5e. . <:ggb 33b
Bonding Company Address
Mortgagor Address
Permit Type (circle one): B U ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION tub-- v c - n e b IA)/?C
.t AAA4 4-ice -c
Square Ft Estimated Cost (value)' 2
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 a
laws regulating construction and zoning. Furthermore, I authorize the above - named.
e of owner and/or Con Presideijt Date
e-4.-/ (4-p
Notary as to Owner and/or Condo Presil Date
My Commission Expires:
Dx iv e az d�z y s2 -/3
Notary
My C . ssion Expires:
I:0 ,
APPROVED:
Zoning Building
Mechanical Plumbing
FEES: PERMIT
/C • RADON C.C.F. NOTARY �. BOND
TOTAL DUE eS-
If
ork will be done in compliance with all applicable
to do the work stated.
to Contactor or Owner - Builder
ate
q)
1 Electrical
Engineering
To whom it may concern:
I Florentino Zervigon as qualifier of the above entity
hereby authorize the following members to apply for permits
on my behave.
Horacio A.Cavanna
Miguel Orozco
Certification # CG CO23801
Expiration date: August 31, 1998.
Sincerely
a
o entino Zerv'•on
State of Florida
County of Broward
Sworn to and Subscribed before me this 14th day of April, A.D., 1997 by
Florentino F. Zervigon who produced a Florida Driver License as ID
#2612 -2 52-136
Not 'ry Public
,,r ., LYDIA NAIT WARD
' '� �': MY COMMISSION If CC 278449
WIRES: Apr 16.1997
o ' Baffled fire floury Putee Ltfdervfdtls
GALPON CORP.
IN/q 7
CONSTRU TION & PAINTING CO.
8579 NW 54thST.
Miami, FL 33166
Ph. (305) 639- 3346/Fax. (305)639.3351
April 14,1997
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