326 NE 92 St (9)Date
Legal Descripti•n Historically Designated: Yes
Owner/Lessee / Tenant
Owner's Address
Contracting Co.
Square Ft. Jo
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
ob Address 3d6 Alf,. ?3 52 Tax Folio /1 3206 0/3 *.o
09 essmv
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
APPROVED:
Zoning Building
Mechanical Plumbing
fi13f1Rb
Address
WORK DESCRIP'T'ION . 6719 //✓ /4./6-- 4s ; ,/-5 /416- it) COD 4 4 4 / /VD
? 7/77i 4/ /iv / J
Qualifier SS# Phone 6, -' 99—Ye
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): IIUEL1ING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING. FENCE ' SIGN
Estimated Cost (value
FEES: PERMIT a RADON C.C.F. � NOTARY
Master Permit # 3 91,s-
Phone t3M- 7 i 2
WARNING TO S WNER: 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.
N. ary as to Contractor or Owner- Builder
My Commission=Expires: -
�i ,\r.,°•A P 41, o :c t.e. NOvi:nv m ..
:
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Electrical
No
or V/3 a , r
or Owner -Bu der Date
Date
TOTAL DUE
Engineering