864 NE 91 Terr (3)9 a PERMIT � APPLICATION FOR R MIAMI SHORES VILLAGE
Date 12" t //7 ( q Job Address %� 4 _
l� f h f h. Tax Folio
Legal Description Historically Designated: Yes No
/Lessee / Tenant gCLW 1 g e ll e d Q I f l Master Permit # // y c/ 3( p
Owner's A d d r e s s la. ^^ ` Phone (305 9' 5 1 - 53
Contracting Co. - A e_ Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
^t
Architect/Engineer
Bonding Company 1I . ; t I Q Address
Mortgagor f ib u Q, \[ II et a IA. A. Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING
WORK DESCRIPTION 14 A'l "- l,( ''' k f ' G_
Square Ft. OO x (O C7
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR LMPROVEMENTS 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.
OWNERS 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.
Signature of owner and/or Condo President
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT RADON
APPROVED:
Zoning
Mechanical
4AI V� on 6 Rigs A- T bh2 Prto -'T
Building
C.C.F.
Estimated Cost (value)
No thry
My Co
FOL
NOTARY
New YC2,4
Signature of Contractor or Owner - Builder ate
as to Contractor of Owner- Builder Date /
n oo nessos NUMBER
CC797277
1. 45 Mr COMY88aON EXPIRES
OF F1. DEC. 17,2002
Electrical
5'
g/000
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"
BOND
TOTAL DUE
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SIGN
Plumbing Structural Engineer
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