469 NE 93 St (4)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor (')
or Builder +4...
Legal Lot
Description
Address of
Building 4.#
MIAMI SHORES VILLAGE. FLORIDA
❑ DATR f 195'
❑ PERMIT N° 650 Contractor's
License No
v
Bl.
Work to be performed under this Permit
BY
Subdi-
vision
Value of�rr Amount of
Project $ 5Z) {J Permit $
This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowied a of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or . ngs cr ir tie statements or specifications and e assumes responsibility for work
done by his agents, servants or employees. — ( , osb, �
�
Signed. �
INSPECT
In consideration of the issuance to me of this permit I agree 'Wsrform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit I assume :responsibility for all work done by either, myself, my agent, servant or employee.
e a'� l.r f
O BuI,
j"il4 Ki �
AUTHORITY
Signat .- `• •
Dat
ysciA ,g);2..
Notary as to Owner and /o
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address q69 Tax Folio
Legal Description
r
Owner / Lessee / Tenant 4//17l/ LIcftic4N Master Permit 4 ,---7-- - --
Owner's Address /34 its /)' t ,P4'I / Phone 6 s - 79 " 9
-7Lr7 ( jr() Go, s 6
Contracting Co. e5G 1 ) Address 7'; K-on 1 S
e/
Qualifier SS# - -
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 PI* /tip e)e2 /d OF z_eJ'e f 6f17' t R6 k id AJi 5 72
L
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 1 applicable laws regulating construction and zoning. Furthermore, I
authorize the above • • tractor to do the work stated.
and /or Condo President
do President
My Commission Expires: `JIY PG9 OFFICIAL NOTARY SEAL
2 t le , ( .. 77 % BARBARA A ANN ROOM! ;c , * OMMISSION NUMBER
** * * * *, : ::r o* CC ;60191* eOF RP MY COMMISSION EXP.
se) MAR. 291998
FEES: PERMIT 32. RADON C.C.77
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * **
Phone
••■
6,6o
TOTAL DUE Y 3,
Fire Other
7727
Zoning B ildi .Gj f 'Electrical
Mechanical Plumbin: Engineering