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1050 NE 93 St (3)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address I() SQ \). g , c y� s -6,C'; Tax Folio 1 1 32.0 5 — V 1 , — 0 S Z. 010.7) Legal Description C \1/4.) 1 cS e. ae., ? e:, tr ‘1 Historically Designated: Yes No f Owner/Lessee / Tenant RR p � 5, C.- f o G., c - '-se. e P , - Master Permit # L0-8 ! 7 7 Owner's Address � S D ti n G 1 S� c Phone 1 S — 1-- Z — z17- C ork.) Contracting Co. it.. 0 n C. 6Z- Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Address Architect/Engineer B Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN n 1 WORK DESCRIPTION trC g A \c -. a, `6S,se \n'Ee ��},r��a`" ��eA:lc \ cl Y J C- V'n Square Ft. ce.04(L_, (114A (%)CC . \ 4) Estimated Cost (value) APPROVED: Zoning Building Mechanical Plumbing 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 - med contractor to do e work stated. Signature of owner and/or Condo President Date ' igna e of Con ' { Owner- Builder o Notary as to Contractor or Owner - Builder Date Notary as to Owner and/or Condo President Date My Commission Expires: ires: _ _- FEES: PERMIT 41 D RADON C.C.F. /. NOTARY 5 BOND TOTAL DUE L /b My Commission Exp Electrical 2-c20©, • r ,� Engineering