707 NE 93 St (6)Date � A ' /pob Address 707 / LE. 4 1 3 57. Tax Folio if — c3.E06, - U /P{ / 7e
Legal Description(5e< Z tcfrg.3 ¢`,Eiy le ( K G Historically Designated: Yes
Owner/Lessee / Tenant M)', 4 "4 S _
Owner's Address '7/ n/ E c
Contracting Co. /) cl n T67
Qualifier .� `�' 7-1 A
FEES: PERMIT - 5/ - 0, 00 RADON
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
(CIO T k / Master Permit #
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Signature of owner and/or CondaPresident Date
T 522.- 01,- �5j -�6�
Notary as to Owner and/or Co
My Commission Expires:
SUSANA SIYOlO
NOTARWPUBUC STATE Of RQRfOA
SY COMMISSION EXPIRES MA al
gJjl1 \cje
sident Date
SS#
Phone
Address i a. ^l'- . l d e r- fl,
WORK DESCRIPTION
fr‘i?
Square Ft. C.3 1 - 1 _ Estimated Cost (value) T 7Oe2
38 I7,
Phone C..30s) 9x+ -
30 — LZ 17.4 v3Competency # / 2 S • Ins. Co. P c ,- ice
Address
Address
State # Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE
73 7 //c � - o y., of &Z f � 7 /1Z f / c / j It f C I
'74" f,t Lam4,1� of ex /n6,7� , ce
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 wo k
Signature of Conti actor or Owner- Builder
Notary as to Contractor or 0 - i der
My Commission Expires:
SUSANA WOW
NOTARY PUBLIC STATE Of RORIDA
MY COMMISSION EXPIRES OCE 22.19
COMM C CC 50394S
C.C.F. , s-5 NOTARY TOTAL DUE
No
SIGN
Date
\q ()A \� v ?(0 Date
APPROVED:
Zoning Building + � iC� ? I f Electrical
Mechanical Plumbing Engineering