1273 NE 92 StDate &/ ob Address / 7� /tie I� -S 7. Tax Folio
Legal Description Historically Designated: Yes No /
Owner/Lessee / Tenant /" Q- /� v / ,( // O✓? Master Permit # gb.O5
Phone �v�.) 73 -y / 4:, -- s ----
Owner's Address / .2 /tie
PERMIT
F
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Contracting Co. �Gff4
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor
/ erfruZ
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION b ' i ' � Wf/ /'�°GtJ �'�'�! ce' /
Square Ft. Estimated Cost (value) 'T'� x-5-0-
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 • • one compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stat
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON C.C.F.
Building jrf�o
Address
Address
Signature of Contractor or Owner- Buil•r Date
Notary as to Con
My Comm OFRCIALNOTARYSEAL
c 4/4 8 MARGARITA MONTIEL
2�'� Cm COMMISSION NUMBER
CC797277
" 4' MY COMMISSION EXPIRES
�F FC DEC. 17,2002
NOTARY
Electrical
BOND
TOTAL DUE
Date
/- / 3- a
Plumbing Structural Engineer