155 NE 92 St (4)Legal Description q
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 4S5 /V-6 90706161 Tax Fo (20
7)vg.eitil
Owner / Lessec / Tenant M2.t i»,Q . .7 L, Z6 t/ / rNI k Master Permit #, r�
Owner's Address ) 5S At t , 9a nc1 Streef Phone 75- - 7 LI L 3
Contracting Cc. 414., Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(cii°cle one): BUILDING ELECTRICAL PLUMBING MECHANICAL FENCE SIGN
ROOF ING P VING
Square Ft. Estimated Cost(value) 74 / d v
WARNING TO WNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESUL'.' 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.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * *
(
Signaturq Fl o - . �.., 1. Owner- Builder
otary as to C
y Commission
* * * * * * * **
FEES: PERMIT fl, RADON C.C.F. � NOTARY . J D O TOTAL DUE /Kg /Rd
APPROVED: Fire
Other
Zoning Buildn_ ` 91 Electrical
Mechanical Plumbing Engineering