1245 NE 92 St (8)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / 7/ Job Address O Ll S/Ut G sr: : Tax Folio
Legal Description ' I Historically Designated: Yes No X
II
Owner/Lessee / Tenant �V O ! I Q.r avid (vn I I I L (+ I Vu Master Permit #
Owner's Address 1; 46 R Z n a Phone /- 5 `l — L 9'0
Contracting Co. I v I C h c) )r (-:- G' S Address
Qualifier SS#
State # � Municipal #
Architect/Engineer
Bonding Company )[
Mortgagor f `
066
Phone
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION A- Flu t IL) 14 v ? 0 Le ,,,
Square Ft Estimated Cost (value) "'1 I O Ci 6
Ins. Co. / - A' fl
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 contractor to do the work stated.
Not
My
Signature of owne and/or Condo President Date
as to Owner and/or Condo President
oBts5lgg 12w t=L NOTARY ark
O. /' SANDRA M MONTIEL
. C . :; 1 .,
+ ii * COMMISSION ?DUMBER
' • 4111 c CC401261
1j• " ' (z, • MY COMMISSION •EXP.
OF FV AUG. 171998
FEES: PERMIT ,1 t RADON
Date
C.C.F.
Signatjreof Contractor or Owne ! der t Date
7-,
Not
My C
• .�� -: ilder Date
difigxpfElp IAL NOTARY SEAL
e. SANDRA M MONTIEL
* * COMMISSION NUMBER
. II, Q CC401261
7? pz MY COMMISSION •EXP. I
OF F\O AUG. 171998
NOTARY ,2 TOTAL DUE
Electrical
APPROVED:
Zoning Building
Mechanical Plumbing Engineering