117 NE 93 St (3)APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
D Job Address //9 /!/ e" £3'J.. Tax Folio 7/ 32 /.3 ;We .Sr
Legal Description - eC / /1f /, 4-6e- A / t4
Owner / Lessee / Tenant 41N(7 J 4NAA1all Master Permit #L 39,( 2
Owner's Address // 7av 1 43 ST
Contracting Co. 6%1.4A-45V Address
Qualifier SS# Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company
Mortgagor
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION l
./ V4O
Zoning
A
Square Ft.
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 con actor to do the work stated.
Signature of owner and /or rondo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * *
FEES: PERMIT` 7 519 RADON C.C.F. .S NOTARY S7 c00
CF A, 0 7
Mechanical Plumbing
Phone 1 7S O Y.3.5
Estimated Cost(value) /6
Signature o
Date:
I ota i as to Co
My Commission E
TrAltir
*
Owner- Builder
SEPHINE CHURCH
**
TOTAL DUE 43
Other
Electrical
Engineering