390 NE 93 StDate q SV 0 4 !� Job Address
Legal Description i
�-�
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
;iv i 1.6 q3 !i_ ' Tax Folio // . t2A0 I..:1 f; ?//
4 719 Al //IL
Alga4
/C( v
*ve ANAL
Owner / Lessee /
Owner's Address
Contracting Co. rj� OW4J l2_ Address
Qualifier SS# - -
State # Municipal # Competency #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBIN MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION /4/ '
/
Square Ft. z g
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
Tenant
Estimated Cost(value)
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 information is accurate and that all work will
be done in compliance with all applicable laws regulating construc/ and zonin ` Furthermore, I
authorize the above -named contractor to do the work stated.
Signa ure
Date: / /l
as to Con 'ratt4 :tmr;:,9yDeA7r.}& , 4
My Commission Exii eg: number f ; .D. produced:
DID rake an oath, or
—DID 1401 take'wm oat& *
*
*
Phone
Permit # c /�o F
Phone ?T "(
Master
Ins.Co.
70o oa
` Y •/ taw�A
OM
** * * * * * * * * *
FEES: PERMIT Y RADON C.C.F. ' NOTARY "'''e TOTAL DUE
APPROVED: Fire
1 t
Zoning Building / l � Electrical
ERNE QNMIfri
art kublic Shit d i
**
Other
Mechanical Plumbing_ Engineering
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
t/ v %ob Address 37 o (U [ 3 % t fT ax F o li o // -9O 0 f 3 Date ��--77
Legal Description I 1" E I /i, / ` �� atorically Designated: Yes No
Owner/Lessee / Tenant g 62 2f SU(I (/ 4 N Master Permit # j 00,7
Owner's Address 3q 0 N 6 'T 3 S7`y, Phone —/ 7o f
Contracting Co. / 6titt f Z 2 Address
Qualifier SS# Phone
State # 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 40/
Square Ft. Estimated Cost (value) ,boo �'
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 information is accurate and that all • %rk will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contrac • - to do the work stated.
Signature of owner and/or Condo President Date Signature f Contact
FEES: PERMIT 4 1a. RADON
Building
C.C.F.
,,rD
or Owner - gilder
Not as to Contractor or Owner- Builder
Notary as to Owner and/or Condo President Date
My Commission Expires: My Commission Expires:
•
Date
Date
o J`�
NOTARY TOTAL DUE '
Electrical
Plumbing Engineering