915 NE 91 Terr (9)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date - 2 k Q? I Job Address A/ q/fA1 9/ .04
' ax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant)/ jern/k5 m evA6, Master Permit # 443 /3
Owner's Address Phone 33 '
Contracting CoX /1 - N.. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle on : BUILDIN a ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 6-1(70 9
FEES: PERMIT
Address
Square Ft. Estimated Cost (value) )c
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.
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
My Commission Expires:
atiire of Contractor or Owner -Buil
Date
Date Notary as t .1 Contract
RADON C.C.F. .. 6 U NOTARY s, () () BOND
APPROVED:
2
,�
Zoning Building j) N ( tOf Electrical
Mechanical Plumbing Structural Engineer
My Commission Expires:
A. Af ..
/PP %__ _
FACIAL ROTAR
' UB ANGELA gA BEC R
l ,- j 0 COP�Hi9f�ON NUPA9ER
We (:0786697
�t . 4y Cnw ISSSON EXPIRES
`c OFF� �� NOV_ 15,2002
TOTAL DUEL 6 6
Date
Flower Bins
Shutters
Awnings
Chimney
Si
APPROVED:
MIAMI SHORES VILLAGE
Paint Color Approval and Agreement
DATEX vl/ & / 1
OWNER'S NAME :,} / n/ 4 us ogV PHONES% 71,
ADDRESS:, Q 91 7 AS, 4 5313 g
* * * * * * ** ************************* . * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
ADDRESS OF SITE: I/ /1/ 7/ 7'
CONTRACTOR & LICENSE (if applicable)
COMPANY NAME: PHONE:
**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
All Elements on the site mutt be listed and indicate the color to be painted.
Walls
Fascia `
Soffit -- ev/ - ft7
Roof V-Ibf
Doors and door jams
Garage Doors
Railings
Fences
Decorative Metal
All brick (simulated or regu
Stucco Banding
Any other stucco features
Accessory Buildings
Other
Building Official
/()/
Date
Pia
Date
Signature of Contractor
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. I authorize the above -named contractor, if applicable, to
do the work stated. Furthermore , the paint colors will be as per the attached
sample
ature of Owner
Date
***************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
WHEN PAINTING IS FINISHED,
CALL FOR FINAL INSPECTION
Date Y
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
z � 9 A /G 9 / Tz,p Tax Folio
Legal Description Historically Designated: Yes No
weer /L ssee / Tenant 07 e.- � v Master Permit #
r -/o33/
' Owner's Address Phone 7 S 9 -
Contracting Co. 0 d..'11 e Address
Qualifier SS# Phone
State # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT 1 ( . . / RADON
APPROVED:
Zoning
Mechanical
7 A /177- // '5 6 - 73 /cr -
-7i / - lvf _/
Building 41 gf zg19b
Sigpa( of ontractor or Owner- Builder
Electrical
Square Ft. Estimated Cost (value) 02 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 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.
Date
Notary as to Contractor or Owner- Builder
My Commission Expires:
Date
C.C.F. / NOTARY TOTAL DUE e i
Plumbing Engineering