864 NE 91 Terr (7)Date
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant RA 1 F Aft, e b1> it Lj ( A N R kit-re /v 9 C Master Permit #
Owner's Address 5 (� 4 qt )j. 1 Y C O (--(" 4 � x'' 5 J Phone (; J ) ?
Contracting Co. Address
Qualifier SS#
State # Municipal # Competency #
Architect/Engineer Address
Bonding Company Q� I / Address
Mortgagor NA is I - Q I'l OV V2 / G g,-). ✓i 1� Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION f
Square Ft.
WARNING TO OWNER:
RESULT IN YO
CONSULT
Application is her
certify that all wo
permits are requir
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
/1 a j ,
e Job Address E64 G Gr Tv f r. Tax Folio
2 ,900
goireS
?''h c AA, .
OWNER'S AFFIDAVIT: I certify that all the foreg
laws regulating construction and zoning. Furthermore, 1 _
Signature of owner and/or Condo President
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT 5' c 76 RADON
YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
— ° — ^v inR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
TnRNFY BEFORE RECORD MMENCEMENT.)
199 8/l
p r L �i addendum (if applicable). I
T I understand that separate
4/E
677/
Date 9t
4 1r
C.C.F. NOTARY BOND
APPROVED:
Zoning Building
Mechanical Plumbing
Estimated Cost (value)
Ce i
.1' Ay 4
otary as to Con to !or 0 �
My Commission xpires:
Electrical
Phone
Ins. Co.
14
npliance with all applicable
C/1/ ?-8
Signat
• , Contractor or O . er- Builder Date
s
-Builder CLADY i J V 1t LAR
NOTARY PJBLUC STATE OF FLORIDA
COMMISSION NO. CC7141G3
MY COMMISSION EXP. MAR. 12GO2
ate
Engineering