520 NE 92 St (5)Legal
l
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APPROVED:
7
Description
Owner's Address
am a
Signature of owner
Date:
r O.
Not dry to Owner
My Comflission Expi
FEES: PERMIT /
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 654 ( Job Address ---6 E l 9;15 / Tax Folio 1 1 320 (p 14 1 1 0 0
Lessee / Tenant Master Permit #
9,z5
Contracting Co. P73 / h `v/1, y &/ R/ Addrressr>77' 0 s 0/52-/U4A)0 !=_-pan,
Qualifier T /
State # Municipal # Competency # Ins.Co. /1(id- holm, -s'
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRI PT ION f 4) l' ?gess fig er ei- A^) // c�
/ 5"! l Estimated Cost value , ®°
Square Ft. Cost( value) �a ��
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 state
and /or Condo President
d /or Condo President_
es: Molloy Public. Sias o
M Commission @apps April 3. 190Q
Bold ltw tilayiwd Ban:lr0 Atroncy
RADON C.C.F.
Fire
Zoning Buildin
Mechanical Plumbing
Si_na ure
Dat : . 2 _yf
Notary
My Co
to Contra
fission Expi
NOTARY
Phone 7 es ir
ntrac or or Owner- uilder
or or Owner Builder , ,
eV C's i lr' ATE
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TOTAL DUE
Other
Electrical
Engineering
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