422 NE 93 St (9)Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE t 1 tl
6//9/% Job Address I ll 2 NE 4 St Tax Folio
Legal Description Historically Designated: Yes No .A./
Owner/Lessee / Tenant Al 4- /M bt7 /9 ,& i / / S Master Permit #
Owner's Address J 79 Nom" 7 - _S Phone /7S --,S--/ 9 P
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION f 4 to7 '� 6.04,976- 49,46 „�)
- 9 - 1-1 '1 & UUUU
Square Ft. Estimated Cost (value)
APPROVED:
Zoning
Mechanical
Notary as to Owner and/or Condo President Date
My Commission Expires:
OC7
FEES: PERMIT '90• RADON
C.C.F. rs ° NOTARY
Plumbing
Electrical
/,s-o- '
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 contractor to do the work stated.
Signature of o and/or Condo President Da e Signature of Contrac Owner- Builder Date
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
cly Char
O)
TOTAL DUE I X6 '
Engineering