155 NE 92 St (7)Date t J4/ N Job Address / 5 /v& Tax Folio /i/j,7A5 /3 ✓/�
Legal Descr4tionGoTo2Q & /
Owner / Les: :ee / Tenant Mgt MQS J01-}AJ 2A UCe -TN1k Master Permit # )-
Owner's Address 5 //9 Phone
Contracting Co. OW Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): :UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION //UST, L1_ T/1 - I5f37 - /V - c6/ 4 - 1
Square Ft. Estimated Cost(value) O
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 F]:NANCING, 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 Signature of Cont ctor or Owner- Builder
Date: Date:
Notary as to Owner and /or Condo President
My Commission Expires:
FEES: PERMIT 4 1 1 `" RADON C.C.F. NOTARY NW
APPROVED:
Fire
Buildin
Mechanical Plumbing
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
A 3 S. s /74
Notary as to
My Commissio
r ecoBiwgeMOVI
COMMISSION NUMBER
CC255237
ms ' MY COMMISSION EXP.
OFF\ -� JAN. 25 1997
**
TOTAL DUE t '
Other
Electrical
Engineering