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1041 NE 93 St (5)PERMIT APPLICATION FOR MIAMI SHORES VIL aa/ /o.� / ,.�_ q3 S r. Date Job Address S4iiii /Q-T71y ''; Tax Folio Legal Description 1-Iistorically Designated: Yes / Tenant EL/A-5 IN1 Owner's Address 10 1 No 93 T ( Phone 7S/-1530 Contracting Co. et- Address Qualifier SS# Phone State # Municipal # 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 A 1 M 1 7'1I G- S71i "4-- -N_D Pt9-1 AVM F L&i 1 Ire t'V / re Square Ft. Estimated Cost (value) I.. I Q ( eoS T CT' FI40 f 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 alcove -named contractor to do the work stated. Signature of owner and/or Condo President Date My Commission Expires: APPROVED: Zoning Mechanical Building Plumbing Signature of Contractor or Owner - Builder Date Master Permit # • Electrical Notary as to Owner and/or Condo President Date 1.Iotary as to Contractor or Owner- Builder My Commission Expires: � paY P0 OFFICIAL Iloin W c '' .6 O �� SAIIIY IA El i. , 01^3Y2: t, is ° COft IViIt -i ' !': "... a CC& © "" 1 01' VIVP FEES: PERMIT lb RADON C.C.F. NOTARY Date TOTAL DUE 15N Engineering