952 NE 91 Terr (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date Job Address i / / . Tax Folio
Legal Description / Historically Designated: Yes No
C .Q�j
Owner/Lessee / Tenant P/ 2 Q Master Permit # �S3 !D 9
Owner's Address of 757 - 7 7 2 0
Contracting Co. CU ;Q7t) Address
Qualifier SS# - Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION jlC 6/7 /
Address
-s-(//:„W
Square Ft. Estimated Cost (value) .:2OG
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 m 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.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT ( " RADON
APPROVED:
Zoning
Mechanical
Building
7? ?// e 30 fi
Signature of Contras yor or Owner- Builder
b ^QS
lit/. / �'c� 7-/e l
ato Contractor or Owner - Builder
nrmssion • fires:
Notar}>
My Co
C.C.F. 6 NOTARY - r BOND
Date
NOTARY SEAL
tADYS J VILLAR
NOTARY PUBLIC STATE OF FLORIDA
' COMMISSION NO. CC7141113
MY COMMISSION EXP. KA% 1 402,
Electrical
TOTAL DUE
Date
g-30
Plumbing Structural Engineer