357 NE 92 St7-(0" e\)(--a--
ERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date Job Addres sS 1\1 �` Tax Folio
VI
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Legal Description
Owner / Less»e / Tenant �j
Owner's Address � 2? . E • "� / � b#2. t . ' Phone '75 - ' % � /
Contracting C Address /2S&
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Qualifier -- - � S ��,��'� ��� - �/:� Ph one
State k1 A �.� Municipal # Competency #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type one): BUILDING(LECTRICA� PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION .471P-/P
Square Ft. 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 construction and zoning. Furthermore, I
authorize the above -named ontractor to do th
ature of owner and /or Condo P ' -side
Date:
Notary as tc. QrMeuendiamigagyPQAti.
My Commissiog
1 !.• � (i.• MY COMMISSION EXP
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•
4AR1NA AA HIRSCH
* CO111401641 @N NUMBER
• CC340646
O 6 *MAR: #.18
lent
work stated.
-
M
y Cominlss
din
FEES: PERMIT 35. RADON C.C.F. v NOTARY
Fire Other
Zoning Building
'. Mechanical Plumbing
3)--o , 03 - i3 - o
aster Permit # 110 (-!3
Si: ature of Contractor or Owner- Builder
Date:
.
r,
Notary as • , - tOiggA iSL,�� ;i1pN NIUSN UAM6 �SBRIi
NER XP � der
• NC r6SCO
vIT ;, Q 'CCJ48646
OF F
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* * - All. 1 ^98 * **
Electrical M
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TOTAL DUE 3- ' �
7)14
Engineering