57 NE 93 St (7)•
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
i \
Date ( y Job Address K � 5 5 Tax Folio
Legal Description
Owner / Lessee / Tenant rP/'r" G-11.1 Master Permit # _1;
Owner's Address S 7 z Ph Sr 2 �` [
one
Contracting Co. O✓t Address
Qualifier SSIi - - Phone
State if Municipal # Competency # Ins.Co.
Architect /Engineer
Bonding Company
Mortgagor
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
APPROVED:
WORK DESCRIPTION
Square Ft. Estivated Cost(value) / v
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 info ion is acc rate : that all work will
be done in -• pl'ance with all applicable laws regula 'ng con t c j�o and .oning. Furthermore, I
ayt.*• ri % the / a ove -timed contractor to do the work st
d� L
Signature of owner and /or Condo President Signs or Owner-Builder
Date: Date:
Notary as to Owner and /or Condo President
My Commission Expires:
Fire
Notary
My Co
** * * * * * * * * * *
CJ 00
FEES: PERMIT 3 - � /�� RADON C.C.F.
AptCP cOUO tMR1td T om' B*�Me - Builder
l L*1IRBA M MONTIEL
�aw` * OMMI4ION NUMBER t
a:�I� Q CC401261
�l� m 4.• MY COMMISSION .EXP."
ok FL° * AUG. * 17,19 , * **
NOTARY c 6 (�
Other
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St) TOTAL DUE LI 3
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Zoning Building Electrical
Mechanical Plumbing, Engineering