500 NE 92 St (3)WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address )C Co Ng 7 S7 Tax Folio
Date
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant ?a,' /a, lJ / Ca,l c,I,,
Owner's Address Phone e 75-9 .- / b y
Contracting Co. Address
Address
Master Permit # £,1Qf; ./ 7)1/
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
9//47 kaA1`e. v v' ard h <11A4 a)
Square Ft. Estimated Cost (value),( 7C
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 AFI.TDAVIT: 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 owner and/or Condo President
Notary as to Owner and/or Condo President Date Notary a to Con
My Commission
My Commission Expires:
FEES: PERMIT
APPROVED:
Zoning Building
Mechanical Plumbing
RADON
v
Date 'Signature of C • tractor or Owner- Builder
NOTARY BOND
Date
pi e = ..RY S EAL Date
ires: G ADYS j MLA-I:
NOTARY 7TT m a. i f:d,l' .'I:
COMMISSION NO air!
§Sdi:
ter•
MvL`.ai� MI`�ST ie1 'ral' i i Im. a . ' r 1
Electrical
TOTAL DUE
Structural Engineer