57 NE 93 St (2)Date 9' / �' D 5'
Job Address ��� 9,�' Tax Folio
Legal Description Historically Designated: Yes N o 1/
�6 m� / Tenant ,/L>f�i9 S .�� k/ c 1 U reiei Master Permit # "7 /a ®
Owner's Address c - J 5 / //i/Q /L// Phone 30 5- 74V
Address /05 & S ,C4
Contracting Co. 4D
Qualifier - TZ y C 1-/
State # O ad // Municipal #
FEES: PERMIT 3S ' 6e;?, RADON
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING I CAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / S f G y
Square Ft. Estimated Cost (value) / O J
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 OF 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 rs 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- r..amed contractor to do the work stated.
Signature . caner and/or Condo Presiden f+ Date
Not. ' as to Owner . 'd/or Condo President Date
M "Commission Expires:
- 32-060-0/ O O
SS# - Phone G ZY- /
Competency # Ins. Co.
Signatupeof Contractor or Owner - Builder Date
t
as to Con actor or • er- Builder Date
My Commission Expires:
C.C.F. NOTARY BOND
TOTAL DUE
APPROVED:
Zoning Building Electrical 4 /� ✓� ��5 2
^hanical Plumbing Engineering