533 NE 92 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date L. `3' 14 Job Address C S f 1 o sr Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant /V �" ,: TO /' &A A Z I' iA Master Permit g' 0 L.. 1 3770 7
Owner's Address �i P 1 72- l - • Phone
Contracting Co. 5 t > r c g- ( I d. Address c i � S 'w I ' I
Qualifier A n Li &?
State # / • Municipal # Competency # /6Z-0 Z0 -g Ins. Co. G h, jI A 9/''' file''
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANICA ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
4 , / a Signature of •wner and/or sident Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
APPROVED:
Zoning
Mechanical
SS# Phone 7T
V-;), ` to i mac/
o e?
Square Ft. Estimated Cost (value) ® � O � `�
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 regulatin t construction and zor}ing. Furthermore, I authorize the above -named contractor to do the work stated.
A wfa
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ignature o ontractor or Owner- Builder V Date
Notary to Contractor or Owner- Builder Date
My Commission $spires:
C.C.F. NOTARY LC e b TOTAL DUE
Building Electrical
Plumbing Engineering