1040 NE 93 St (8)Date Job Address /O ' ® A) ?3 d Tax Folio
Historically Designaae Y
R Owner/Lessee essee / Tenant � � l 2� C �� (i = ast�i l4erm #)
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Owner's Address �� � � 1\4, J t Phone (3)
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Contracting Co. (/ /� � (� , } 1(511 � Address � d — e �G i!V" j ,,-*WZ
Qualifier . SS# Phone
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Signature of owner and/or Con President
N o , tary as to Owner and/or Condo President
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,OP'YIEL
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OF F\. LAM 97, '
FEES: PERMIT Ile JP RADON
APPROVED:
Zoning �!
Mechanical 1 V
PL /) S vi_ 1/e-7/
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Plumbing ■
FG i?/
Date
Date
State # / Municipal # ^ / Competency #
Archi ; ��
fect/E nngineer i 2 ✓l c ! (/lc t—�Jr Address
Bonding Company Address
Mortgagor / / U
Address
c›? ?
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENC
* ?
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. Furthermo&e, I authorize the above -named contractor to do the work stated.
Building
go ,2_ mac , 42 #' i
3/f?
/( -JCS L- J l
e of Contractor or Owner- Builder
- �1
Notary as to Contractor or Owner- Builder
My Commission Expires: _
•Y U 6 , r t4, iA� ^
•
C.C.F. Z 0 NOTARY 5 e
Electrical
Engineering
Ins. Co. -
5/-0
(J'
No
rip 2
Date
BOND 661.
TOTAL DUE j
1/7 r- l:1
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal Lot
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
CI
DATE 195
❑ PERMIT N? 5 812 Contractor's
License No.
❑ Work to be performed under this Permit
CONTRACTOR OR BUILDER
B1
Subdi-
vision
Value of
Project $
I
Amount of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed. BY.
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
BY AUTHORITY