707 NE 93 St (8)Date
Legal
State # / (J
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
7 711
Job Address 107 t/ qc /— ' Tax Folio ! (— 3 z..O 4 - O / '_ / 6)O
ption .S �Z J z31 ' Z . Historically Designated: Yes
Owner/Lessee / Tenant r ' TAW T 7 A £„L Master Permit #
Owner's Address s�= Phone
Contracting Co. ( %� j4 f'' i(/, Address .0',69( 6 /(�bCCf6^
Qualifier 6
l A1 �' li i AA 7— E12/90/ 44# . 2hone t._ -). U / / 260 3
Municipal # Competency # 7Z/OO Ins. Co. 41. - V *
c V e'L ,5 1` .- 2 ,
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost (value) 7e)5'
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 . , . MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate'and t all work will be done in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above- npirred ' orliractor to do the work stated
S-7 -9
Signature of owner and/ do President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
APPROVED:
Zoning
Mechanical
q4;AJT Gtr` /J LU.5 >Cf/_- I D R
FEES: PERMIT ',CO, O 0 RADON
Building
Plumbing
ntrac or or Owner -Bu
Signa
/g/i44
No
er Date
1
\ C�� 62J.A&vA_, - 8 ^ % ,
Notary as 'o Contractor or Owner- Builder Date
My Commission Expires:
CLAUDIA SORIANO
MY COMMISSION 0 CC 460251
X111
; %�'''�`• EXPIRES: May ], 1999
'' '••' Bonded Nu Notary Pudic lkidenentpxt
C. C.F. , cfa NOTARY S• TOTAL DUE 5 1 fb
Electrical
Engineering
MIAMI SHORES VILLAGE
h BUILDING DEPARTMENT
pY 305- 795 -2204
Building Inspection Request
DatgK
Type Insp'
Permit No.
Address
Company
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
P�..�-
Name�� h I L cc,
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