478 NE 92 St (2)Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 5/ 0 9z" Tax Folio /- ,��,, , 0/7• 60 .>
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant / "' fl2 /Co S t 4 Master Permit #
Owner's Address 7 g � 612- AIM/
/
Contracting Co. t / S Q/ G �: /L / Address S S AI (/
Qualifier 2 eR. (r � a SS# ) Phone i
State # Municipal # Competency #
Address
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDIN Q t ECT CAI LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION "ez,- /4
Notary as to er and/or Co ' do Pr
FEES: PERMIT
a/
Square Ft. Estimated Cost (value)
RADON
Date
33, Phone 3 c 7 - .
Ins. Co.
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 cow ction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
/
Notary as to Co ' ctor or Own-. - Build-r Date
My Commission Expires: My Commission Expires:
C.C.F. ' b V NOTARY a -- BOND
TOTAL DUE
APPROVED:
Zoning Building Electrical���j 0 4V,' 7/9
Mechanical Plumbing Engineering