560 NE 93 St (3)Date
Legal Description
/ Tenant
Owner's Address
Contracting Co.
Qualifier ,s( /
r.J `
State # F/
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address
4 2 . (/ 72ol A
S'4 24 9
560
('9-I/9/'4 L
Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN
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 -named contractor to do the work stated.
Signature of owne ' and/or Condo President
Notary as to Owner and/or Condo "resi
My Commission Expires:
FEES: FERMI
Date
OFFICIAL NOTARY SEAL
BARBARA ANN FUGAZZI
COM SSION NUMBER
CC723468
t5Y CO AAtViISSSON EXPIRES
MAR. 29 2002
RADON
Date s;� orcc
Date Signa a of Contractor or Owner- Builder
C.C.F
Historically Designated: Yes
APPROVED:
Zoning a Building
Mechanical
Of/9
935 Tax Folio
Notary as to Contractor or Owner- 'lde
My Commission Expires:
NOTARY fU BOND
Electrical
No 0(
C 4 /303 -3) X 3 ?'f
Master Permit #
Phone C 3°5-) 7 - 5 3 Z,
Address / 2 2 9
ss# Phone 30S — S 3g -00 cs
Competency # Ins. Co. 4'•X /71/ ./tea -r •ri
Address
Address
ROOFING PAVING FENCE SIGN
CZ 14
0 a '7 ,
TOTAL DUE
Date
OFFICIAL NOTARY SEAL
O•\P P4/.9 BARBARA ANN FUGAZZI
e.
2 { 0 coOsuassom NUMBER
a q ' ' d < CC723468
yi Q O MY COMMISSION EXPIRES
OF F` O MAR. 29,2002
Plumbing Engineering