357 NE 92 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date � 7 Job Address 3c r] it/c 5 .. a Tax Folio
3 S '7 a.) 9 a "° St. Historically Designated: Yes 1� No
Owner/Lessee / T `'3' 2 v Master Permit # "7 Z3 ��
elletl� � cJ CTL�. 11M1 P �
Owner's Address -2 )S - 9 (1SE C f Phone 5 - l7G e
Contracting Co. x N ` r.. M A r c K 3' /' h a. %,` •- h Address l 63 a/ 6 c- / y/ if v e
NI v•-, : /` Jai
3°5 2-57
Legal Description
Qualifier � � / if.' y -5- F 4 r h ; ° - SS# Phone
State # G' 13 co 5 l L Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one):
WORK DESCRIPTION
amtf L V\ t
Square Ft. Estimated Cost (value) . 156 62)
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, PLUMBIN , IGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing ation is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I autho e the above -named contractor to do the work stated.
My C
e of owner and/or Condo Presi
Notary a to Owner and/or Condo President Date
•
O . U B FFICIAL NOTARY L
ei SANDRA M 1EL
4( a * COMMISSION NUMBER
4.:.i ' CC401261
�.� "4- c� MY COMMISSION .EXP.
@Ff�Q A
1 4 B
FEES: PERMIT
APPROVED:
Zoning Building
Mechanical
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
ArYt e rrAt h / t7 k't7 G2.c.)A C. n •l At 6S
Signatue of Contractor or Owner- Builder
Notary as to Contractor or Owner - Builder
My C. pp. 1 :. ...n F.- x es.
Y P . OFFICIAL NOTARY BEAL
0 B e . SANDRA M MONTIEL
2 34 n COMMISSION NUMBER
Q CC401261
Q_ MY COMMISSION EXP.
(4 '0F 0.. AUG. 17 1016
C.C.F. NOTARY
// 2- gf
Date
Electrical
BOND
Date
(/2/9
Plumbing Engineering