365 NE 93 St (6)OWNER'S NAME
155 A BLE 14cpLEr
.I PRESENT ADDRESS
36+C nl •E t't S'-
LICENSE NO.
PHONE NO.
JOB LOCATION (ST. OR AVE.)
("D S4 .
331* r ►.J • c . /3
LOT -
SC f 4.-% i i 2. 74I
BLOCK
4!o
SUBDIVISION A
I kl. Oh. 11. nn .oL e s Mrn pirb a...La
GENERAL CONTRACTOR
C O M) Y now 31 Q. `1 i Oh./ C •
ADDRESS
- 7 (o b N • L . (1 1 •"' Sr .
PHONE NO.
LICENSE NO.
Q �j
BUILDING PERMIT NO. • • 4) �
- }�
3 `. 8
DATE 2- - Z (
PERMIT FEE $ td • �
BUILDER'S BOND
NO. `. DATE
ZONE REQUIREMENTS CU. FT.
PLAN CUBE 4 1 14 . c1 CU. FT.
EST. COST $ 2 42o0
/f l
DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: 1 -•• - • • . '/'� 1�
1 2. Z3 DATE
NEW CONSTRUCTION
TYPE
C....116 S
STORIES
One
ROOF CONSTRUCTION INTERIOR CONSTRUCTION
..Z ea • (4. •.,p . 1 f 12s. c Ate.
TL.O�IDA
REPAIRS
DESCRIPTION
A00,-/ ` r o ttC"s-- ¶E* "2 Z 0 It- � ft- ei-STtsic_ED
DESCRIPTION
ALTERATION
w
(S 44 0 CEcitr►Q - t-e--1=O - tco..-SE -."-
ADDITION 1 >� 4
SUBMITTED TO PLANNING BOARD
APPROVED
REJECTED ` REFERRED TO COUNCIL
REASONS
RE- SUBMITTED TO PLANNING BOARD
S(IBMITTFD TO VILLAGE COUNCIL
REMARKS
CERTIFICATE OF OCCUPANCY NO,
ISSUED
BY
TO
BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE
INSPECTIONS
DATE
BY
INSPECTIONS
DATE
BY
FOUNDATION
ROUGHING
I $
ROOF
TEMPORARY SERVICE
I $
BEAMS & LINTELS
$
$
POOL
I $
FRAMING
�:
AIR COND.
MOTORS
FINAL
$
FIXTURES
CLEAN UP
SEPTIC TANK
S
SLAB
4
SOLAR HEATER
SLAB
FIXTURES & FINAL
SPECIALS PERMITS
PERMIT NO.
DATE FEE
TEMPORARY SERVICE
BY
I $
SEPTIC TANK
ROUGHING
I $
SEWER
TEMPORARY SERVICE
I $
SOLAR HEATER
$
$
GAS
I $
RANGE CONN.
�:
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGHING
DATE
FEE
TEMPORARY SERVICE
$
TUB & TOP OUT
$
RANGE CONN.
H. W. HEATER CONN
SEWER
MOTORS
$
FIXTURES
SEPTIC TANK
S
4
SOLAR HEATER
FIXTURES & FINAL
FIXTURES
GAS
CONTRACTOR 1ZAY PO t e l ate. EC-. I AJCC .
PHONE
PERMIT NO. 471 /$ I DATE 3 12 .
FEE 3.8.°
NEW BLDG. 1 ALTERATION 1 ADDITION
REPAIRS
SPECIAL PERMITS
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
$
RANGE CONN.
H. W. HEATER CONN
$
MOTORS
$
FIXTURES
S
4
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
TEMP. SERVICE
ROUGHING
H. W. HEATER CONN
RANGE CONN.
FIXTURES & FINAL
CONTRACTOR
PERMIT NO.
NEW BLDG.
BUILDING INSPECTION up s , ',tee
PLUMBING PERMITS & INSPECTIONS
DATE
I ALTERATION I ADDITION
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE
PHONE
FEE $
REPAIRS
1w
BY
OWNER'S NAME
1,L A Y C IZ.E v E L o IJ
PRESENT ADDRESS
9.0. 'b - i Sit 6 ; kb/ e 5
LICENSE NO.
PHONE NO.
JOB LOCATION (ST. OR AVE.)
3(.5 1./. 6 , 93 Si.
LOT
, .,4
, ZS # [J 2 '
BLOCK
41..
SUBDIVISION
I41 Ar., ■ s »(. Sea -7
GENERAL CONTRACTOR
f_ ..4.4 C =41,1
ADDRESS r�,
7 ` o 1J. E. 1 1 7 - ) 3,1 c.: .
PHONE NO.
kiLr . ,
LICENSE NO.
epe„.... i q
C l
BUILDING PERMIT NO. / I
Q
DATE a -(6O- 1. 7
PERMIT FEE $
BUILDER'S BOND
NO. Z �� ^ 1 DATE fr-ic. (1,1
I L - Lo
ZONE REQUIREMENTS Z • , ca•�tr7 C U. FT.
PLAN CUBE Z, I CU. FT.
NG
EST. COST S 2- Z, agn
DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY LCD -2 f , ee.-e( 4 t
DATE
f� ~L
NEW CONSTRUCTION
TYPE
c 6S
STORIES
o., d_
ROOF CONSTRUCTION
- 7 - , %
INTERIOR CONSTRUCTION
e72-,z 6 a Z o F o,z.s
REPAIRS
DESCRIPTION
PL,- a % 9L� ✓J (.JA- -3 �' Z , / .t - f p 4.):::„..1' Se ,-......0 � r
ALTERATION DESCRIPTION
ADDITION 7 /e ,S,7/ s
SUBMITTED TO PLANNING BOARD
APPROVED
REJECTED
REFERRED TO COUNCIL
REASONS
RESUBMITTED TO PLANNING BOARD
SUBMITTFD TO VILLAGE COUNCIL
REMARKS
CERTIFICATE OF OCCUPANCY NO,
ISSUED
BY
I TO
BUILDING PERMIT AND INSPECTION RECORD —MIAMI SHORES VILLAGE
11, • cr
INSPECTIONS
DATE
BY
INSPECTIONS
DATE
BY
FOUNDATION
I
DATE
ROOF
TEMPORARY SERVICE
BEAMS & LINTELS
Id . Dane
� 6-P71 c._ -r..- .16.-
POOL
$ -
95
FRAMING
SEWER
AIR COND.
MOTORS
$
FINAL
$
SOLAR HEATER
CLEAN UP
1
$
SLAB
GAS
1
SLAB
$
"
'.,-,
SPECIALS PERMITS
PERMIT NO. I
DATE
RE- INSPECT
FEE
RE- INSPECT
TEMPORARY SERVICE
I
DATE
$
TEMPORARY SERVICE
SEPTIC TANK
Id . Dane
� 6-P71 c._ -r..- .16.-
`Q .
$ -
95
RANGE CONN.
SEWER
I
MOTORS
$
$
SOLAR HEATER
1
1
$
$
GAS
1
$
"
'.,-,
I
INSPECTIONS
DATE
BY
RE- INSPECT
BY
RE- INSPECT
BY
ROUGH ING
DATE
FEE
TEMPORARY SERVICE
$
TUB & TOP OUT
RANGE CONN.
$
RANGE CONN.
SEWER
MOTORS
$
FIXTURES
1
SEPTIC TANK
$
S
SOLAR HEATER
FIXTURES
GAS
- c-Z / t e_'
CONTRACTOR il- At-- 13 1. -� Z
PHONE
G
PERMIT NO. t .2 - � 1 DATE 9 - .(- 7
FEE $ ' ZS . ' 4 p O
NEW BLDG. 4 " 1 ALTERATION 1 ADDITION
REPAIRS
SPECIAL
PERMIT NO.
DATE
FEE
TEMPORARY SERVICE
$
H. W. HEATER CONN.
RANGE CONN.
$
RANGE CONN.
$
MOTORS
$
FIXTURES
1
FIXTURES & FINAL
$
S
INSPECTIONS
DATE
BY
INSPEC BY
RE- INSPECT' �- BY Y
f 7 -(. I �'�
I
TEMP. SERVICE ii-441-6
a�
s� RE-
/ a. [ I/ 4/ -
ROUGHING
H. W. HEATER CONN
RANGE CONN.
I
1
FIXTURES & FINAL
I
N
t
BUILDING INSPECTIONS 44.. Y2a�L N`
PLUMBING PERMITS & INSPECTIONS
CONTRACTOR do ® - E • L
PERMIT NO.
NEW BLDG.
6 I DATE
ALTERATION
Vmow,
;- Ca
ADDITION
PHONE
FEE $ .
REPAIRS
ELECTRICAL PERMITS & INSPECTIONS
APPROVAL TO POWER CO. FOR SERVICE DATE
BY
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Application is hereby wade for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Date_ - ._ - - -1 - % S 19_4,7
Owner's Name and Addressc_. E�� __. _.. �. (f No Street(.Y_5?"h_a'.�.a rtui
Registered Architect and /or Engineer._. - ____. -_ . �ltAite��
Name and address of licensed contractor_.__ ! 1 .. - 74 _ f1 ?. _ - �-
U Ec�
Location and legal description of lot to be built rt � . d �, •
Lof g
-74-4 V/310117 Subdivision ` A- ' ^ '■+-
Street and Number where work is to be done 3 66)612 s-
Sta work to be done and purpose of building (by floors) Cou $ ra -o-GT 3 e- 4 4.- ��► - �+�
Estimated Total cost of improvements 0 0 A
Zone cubage required -1 .°, ®"
Distance to next nearest building___.___.
Maximum live load to be borne by each floor___
New Building ✓
To be constructed of_.2_ e 5 Kind of foundations eASN .
Amount of Permit $ • ° t3
plan Cubage- _.. if _ .
Remodeling _._____ Addition Repairs No. of Stories
Roof Covering___ ---
L1
Size of Building Lot
Notary Public, State of Florida
PLANNING BOARD__ __ . DATE
Chairman _ . Member
Member _ Member
Member .. __ - . Member ...___.._.
Council Approved_ _______ ______ _ Date Disapproved
(Signed) - --- S
, I
1( 61
and for no other purpose.
I hereby submit all the plans and specifications foi said building. All notices with reference to the building and its construction may
be sent to-- -- - = -
The undersigned applicant for this building permit dot hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
C Permit No ........ Date 9 ' !� - `Z__ Read, Sworn to and Subscribed before me.
Disapproved ____ _. _ _ Date
n •
( Signed) I. •- - - - --
Build' f _ Inspector My Commission Expires._
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.
FL, n
•
33` -6 :y
9 '
so ��
a
'off ea -"6a %a s�
e_
•C rz7
PCB` 0,tr FEE
11 Bo . ' Z l
1 r. o
z1 5-
f
c
'N 4, - z/ 6
e,
?. 0
4 17 /
¢ o�
F see . - 6
BUILDING ❑ MIAMI SHORES VILLAGE, FLORIDA
PLUMBING
ELECTRICAL 0 PERMIT N °• 9176
ROOFING ❑
A I c . p
Owner of
Building I-- +--• `• 4.4.. L o 04
Architect
Contractor
or Builder / " ! 1 • • 4 Cr
Legal Lat
Description 11 131
Address of � ...— r`S _ .._�
Building L .!
CONTRACTOR or BUILD
Signed • t
Work to be performed under this Permit 4 l Tai I b..
LC: t K.
Date 1 — f r 196
Contractor's
License No
•
� a J. 0,10 C
Subdi-
vision
Sq Ft (
Value of p ` J� `' V 11 Amount of 1 ��
Project $ ' ` 11 Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or (drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, selvants nLemnlnvee� _ k
i
BY
In consideration of the issuance to me of this permit I agree t' -rform the work covered" ?iereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, -ments or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this rmi I assum responsibility for all work done - either, myself, my agent, servant or employee.
BY AUTHORITY
Sadr"b•• ..d . ?4
BUILDING 1E MIAMI SHORES VIL E
, � � �� � —_
ELECTRICAL ❑
PLUMBING o PERMIT N °. 9071
ROOFING ❑
w-t( . it
Building f !1 1° Cot - c' V C. t._...0 e4 '2 k i n {? is
Architect G• t 4 t 1 t t. ( rl ,L k". t:
r
Contractor r te ' ,�
or Builder 3 IA , t_ C -C .r e 7 Cr LA 1. 1 .. d t 7 1::, `;,C. . / • i .c 4 ---- _ _ �
Legal Lat � la r ? Subdi- ("'
J 1
Description '�` ;"`'� 7 7 �� I 1 131 4t.. vision J�z! ,' r-1 r r� c ���:,_ ;
Sq. Ft. - -
Address of 5. ?Vi f -, �l Amn � � Building 40 � C J ) T
Value of Project $ d' t> ,
p Pe ou t $ of r —
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on'... the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants. r emplo yes. / I
Signed �+"' �: ---e' (INSPECTOR) BY
In consideration of the issuance to me of this permit I ag to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawi , statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting this permit I assume responsibility for all work d by either, myself, my agent, servant or employee.
CONTRACTOR or BUILDER
Work to be performed under this Permitcl. -'S : (--'c v.
Contractor's fr�+ ■f ∎ { q
License No.
BY AUTHORITY
41
Application is hereby made for the approyal of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
,19 67
Owner's Name and Address P V I NO) . 1_ R P Ng. a No. 63 Street- - �f•
.._ �/ __k- 9 _ -3 -re
Registered Architect and /or Engineer
Name and address of licensed contractor__Ati _ 1hAl.b.ER 5 Cnki.p.O.R.ei.7_4i'd g S• /i.x.1g._/1 ' S. . 4ftn. /..F'A
Location and legal description of lot to be built on:
, ' 2, i
Lot. , 70 1
J Block ill Subdivision .LJ1QAI --- SIIORES._ -_ Sc. i� IVFz- __A151iFNbE . D /_KID P 7
Street and Number where work is to be done 10 6 3 NS_ c__sr
State work to be done and purpose of building (by floors )1 t 2J.OPJ REtigilhill.fif g- C!lAU ___Jt S£._9F RIPG."
New Building
MaAMI SHORES V 14.AGE
lBV. ,DING INSPECTION DEPA8.7MENT
APPLIr/ TION FOR BUILDING PERMIT
Date
® 33
and for no other purpose.
Addition Repairs No. of Stories � -
Remodeling
To be constructed of _._ f A Kind of foundation , /9 Roof J overing AIM
Estimated Total cost of improvements $2 .-P Amount of Permit $ /C '
Zone cubage required _Plan Cubage__
Distance to next nearest building Size of Building Lot /00 X. I 11•Tre
Maximum live load to be borne by each floor___ if lq
I hereby submit all the plans and specifications for said building. All notices with reference to the building, and its construction may
The undersigned applicant for this building permit hoes hereby certify that he understands and accepts is obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site if the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this
permit, as are licensed by Miami Shores Village.
Remarks _ - -- . (Signed) e,.�l ,
Notary Public, State of Florida
Building Insp: tor' My Commission Expires.
NING BOARD__ __._ DATE
Chairman Member
Member __ Member
Member - Member
Council Approved________ _______ _ _Date Disapproved
STATE OF FLORIDA,
COUNTY OF DADE. ss
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him sta
Permit No.___1 � td e
__ . Date / Read, Sworn to and Subscribed before me.
Disapprovedd : s (! �� _/�
(Signed)
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper not for insi..ion or faulty
materials and /or workmanship.
Application is hereby made for the approyal of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
......--- Date , 19
Owner's Name and Address. ..... - /72 - CD Z z—y .0....3., 6 stieet 9,5
,
Regiitered Architect and/or Engineer .........
Name and address of licensed contractor.. _CC.? 7) ,Y re / -'• / .
Location and legal description of lot to be built on:
Lot_ Block Subdivision
Street and Number where work is to be done 3_5T Ate E. 9 3 sr
State work to be done and purpose of building (by floors) P/97
and for no other purpose.
New Building Remodeling Addition Repairs No. of Stories
To be constructed of Kind of foundation. Covering
evil>
Estimated Total cost of improvements $ Amount of Permit $
Zone cubage required _Plan Cubage_
Distance to next nearest building__ , Size of Building Lot
Maximum live load to be borne by each floor__
I hereby submit all the plans and specification fc said building. All notices with reference to the building and its construction may
—
be sent to___
The undersigned applicant for this building permit doc hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen s Compensation Act, being Sec:ion 5966, Compiled General Laws of Florida, Pennanent Supplement,
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him
in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su actors, on workjQ be performed under this
permit, as are licensed by Miami Shores Village.
Remarks ( Signed)
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared ------
........ ...... _ _
and who, being by me first duly sworn, upon oath deposes and says that he is the .....
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No ........
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date_ Read, Sworn to and Subscribed before me.
Disapproved ____ _ Date
( Signed) ..........
Building Inspector My Commission Expires..
Notary Public, State of Florida
PLANNING BOARD. DATE
Chairman Member
Member Member
Member Member
Council Approved _Date Disapproved
to me well known,
Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re-inspection fee of 51.00 will be charged when such re-inspection is made necessary by improper notice for inspection or faulty
materials and/or workmanship.
i e+ic.ic e5=d e o
5
e
Owner / Lessee / Tenant
Qualifier
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date 6 z y Z Job Address gar /../.6". 4 3 ST
Legal Description �Sf t IIZ
Owner's Address - .q -M,f' .es /1 5• -. Phone
Contracting Co. /AP.tj -/ /.s
✓ ✓ q-.✓ .efsA
State # Municipal 1t
2 G z— 23 Z
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION � .y i;4o -^ r ,
Square Pt. Estimated Cost(value) 4 ' 4.
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 informatio
be done in compliance with all applicable laws regulating co J ctio
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:
** * * * * * *
FEES: PERMIT c "..(00 RADON
APPROVED:
Zoning
Competency # Ins.Co.
*
C.C.F. NOTARY -rr 00 TOTAL DUE 3a DP
Fire
Mechanical Plumbing_
Address
Tax Polio 11 d' 96 13 6 O 2
Master Permit #t ,3'g ,-0
,L // .rs✓ I go 4-4 ,r
s accurate and that all work will
tar as to • ntnagitprinaz ngicelvarklA431V
y Commission ExTpir :nhm er of I.D. produced:
❑ DID rake an oath, or
* * * DID iNNPT take in oath. * **
Other
,JG11/ Electrical
Engineering