43 NW 91 St (3)Signature o
Date:
APPROVED:
Date / ' F 3 Job
Legal Description
(Owner / Lessee / Tenant
Owner's Address
Contracting Co. '1 COPY Address
Qualifier SS# -
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
Square Ft. Estimated Cost(value) 500,00
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 omplianc ith 11 applicable laws regulating construction and zoning. Furthermore, I
a oriziethe abov-- a ntractor to do the work stated.
otar as to Owner
My Commission Expi
** * * * * * * * * * * * * * * * 2 **
FEES: PERMIT ,7 7' RADON C.C.F. i � NOTARY .; DI) TOTAL DUE if34' 4
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
&kepi'
Hou,S
er and /or Condo President
43 / V Gk Tax Folio 37" /7 1 / 0 �
aster Permit ;3553/
Phone 7C/ ` 5
Phone
Signature of Owner- Builder
Date:
Notary as to r Owner- Builder
My Commission Expires:
Fire Other
Buildin: 9 7 Electrical
Mechanical Plumbing Engineering