551 NE 93 St (12)Date Job Address -5 Vie .'
Legal Description #'1 /9'
Owner / Lessee / Tenant )
77 .s"/"
Owner's Address
Contracting Co. �Q�f/1���rt/� Q2.�1iL
Qualifierr4,,7 % Q.0 a tr i. j. ss# -
State # Municipal # Competency
WORK DESCRIPTION
Noy =. to Owner and
My Commission Expires:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
JOSrPHINE CHURCH
•Notary ". bhc, State of Florida
p; Ft[er§niid @4i "P. April 30, 1996
'aA, o °: No. CC197545
Tax
Address
Nbtar
My Commission E
** * * * * * * * * * * *
FEES: PERMIT ✓ O / ∎'5 RADON C.C.F. /1 O' NOTARY 5 D
APPROVED: Fire
Zoning :uildin
Mechanical Plumbing
Folio// /c / "/ 474 8'
Master Permit 4ti%/e
Phone / J��� c ? X97
fi7AC /A/
Phone 5 X369
4t~ Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost(value) eGP
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.
Signat r o Contractor or S- Builder
Date : ® j/
as to Co
' . JOSEPHINE CHURCH
mardavg.
RI( Commission Evirsorionsi
No. CC197545
TOTAL DUE ? SO
Other
Electrical
Engineering_