386 NE 92 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 5G2 Job Address 3
WC
Legal Description cAta , Ke-S Sc. a ,t, - P110 -70 Historically Designated: Yes
I * NV-
/ Tenant 4 y le G f' &/L
,3�� / /Ve 9,z 5P-
ii- e-o rs -6112_0
Master Permit #
3 7gg
No
Phone Z - 4f
�J �
P e. Contracting Co. U " 5' 1 Address 4,44-) 7J ~-
Qualifier 7-'0 /C> 6
Owner's Address
State # dfrCo24 WO'
Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN ECHANIC ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /''e" !%tl 's r
��s ;�
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 -n., ed contractor to do the work stated.
Signature of owner • or Co do President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
". M.t'i LiER
of Florida
My Coma .r;pir";S July 7, 1098
l a. CC390801
FEES: PERMIT RADON
//GJ , yt 1 �"
e of Contractor • Owner -Buil
Notary as to Contractor or Owner - Builder
My Commission Expires:
E; SINE WALTER
Woiary Public, State of Florida
My Comm. ar;9ires July 7, 1M
5
• tiro. Ci:c£�afiA
C.C.F. 5 NOTARY
Electrical
TOTAL DUE 6040
Date
Date
APPROVED:
Zoning Building
Mechanical i� Q ,:r / Plumbing Engineering