423 NE 92 St (13)Date 0 4/ - l79 -6 () Job Address (-/ 23 J . q2_ Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant . 5 A (A) fl R (M f) Master Permit #
Owner's Address Phone ,S 7 S - / (
Contracting Co. (9 CL) Q R Address LI L Jkt E °I z S T
Qualifier SS# Phone
State # Munici 4 , npetency # Ins. Co.
Architect/Engineer ress
Bonding Company ss
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION V f/ PI 1 6 7( i A e R l ► U r 5 cA. R i` i c to n-4 cc 1oc c)
i wi w A 1 l o . Fa S C iq b a cErri S+ F (cc S 1 t i my
Square Ft. Estimated Cost (value) 3o 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 owner and/or Condo President Date Signature of Co
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT '51)
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
RADON
APPROVED:
Zoning Building
Mechanical
tor or Owner - Builder
Notary as to Contract or Owner- Builder
My Co
S
7
OF 0.
C.C.F. <P NOTARY
Electrical
ires{?incIAL NOTARY SEAL
lerniqtyl
TOTAL DUE '5: k
Plumbing Structural Engineer
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