355 NE 93 St (5)Date
. 1 _ , 6 - v i - S6 - ' -D
PERMIT APPLICATION FOR MIAMI S ORES VILLAGE
I Job Addres3 ) /1/& Y 3
Tax Folio
l 6 320‘ 017 ‘2.c ? o
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant�(a - Pel P Do M, Master Permit # ' V A
Owner's Address -25 j N t 1 q3 s\-
Contracting Co. D\ L4 ,2Pr/ ~/ r-- t®
Qualifier y vow YI c( .11; I I et SS# _58 qi - /3 - *COI Phone ( 6) _43 J'.i 9 6?
State # t -0000 1 h 9 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /n S //l ,1 / ,4)G
Phone(305 169 - F 7
Address j1 L/ 1 364 #/60-D
rU/1 d a bevrceos
Square Ft. Estimated Cost (value) l 9). f 50
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wi be • . e m compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the wor
Si of o er and/or .3 do President
Date
(o
Notary as to Owner and/or Condo President ate
My Commission Expires:
HcA„ NOTARYSEAL
ALBA C.JCNA
ie iQ ARY PUBLIC br CJJ" W,,17;i DA
COMMISSION NO. CC8SE3343
yY COMM1SS10 EXP. Y ?;. ^x .Jli
FEES: PERMIT el Q' RADON C.C.F. U
APPROVED:
Zoning
Mechanical
Signature of Contractor or Owner- : ui er Date
Notary as to Contractor or Owner - Builder
My Commission Expires:
AL WON
AiOTARY PUWC STh : f3 7 n*auaa
COMMISSION NO.
ISSION EXP. °T.,. $tea
TOTAL DUE ,d V
Building Electri
0
Date
Plumbing Structural Engineer