709 NE 93 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 7z9 9 ` ,S Tax Folio o O f - I P790
fir r S /N o'a s . G 3 �3 /0- ,3 7
Legal Description A or s/a,r_ 7 5, coo ac + a i o e_. / ago– Historically Designated: Yes
O er / Tenan
(Owner nn 0,412 *(12. t Thci / 2 l ... _Master Permit #
Owner's Address 1 / lv��, e!/i,a /f4c3o ,ct
Date
Contracting Co. A - / ,4'3J../r= R067
m
Qualifier j n /G/j , 2Q
State At:r 1 1 S
Architect/Engineer
Bonding Company
Mortgagor
Address
Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL
WORK DESCRIPTION _ 5 SQ F• , t) 4c r. ', if C�
Square Ft.
APPROVED:
Zoning
Mechanical
Municipal #
/1702
N��
otary as to Owner Condo Presi
My Conunission Expire ,
EL
ce e~Ci972 _
F�� 4) �
a ' oix: as81on EXP
8F
FEES: PERMIT RADON
5 17,2002
Building
Plumbing
Phone(g06) 95
No
95 ?07
Address ,5"`7a2 5 /�,1/hx/,d6.v ,.2 . 4.976 P/laii3 3 3 36
ss# - ' Pho e 95-j) o -,? 3/
Competency # 3 3,6 3 Y7 Z ns. Co. 4-11 t w C.i,,v c2
Estimated Cost (value) /c Ck .�.
gnature of Contractor Owner-Builder
C.C.F. a ry NOTARY
Electrical
0
BOND
G�
ti
ROOFING PAVING FENCE SIGN
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOU
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 ail work
will be perf to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PL �: G, S GNS, P S • e o . I G and MECHANICAL WORK.
11 the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
I authorize the above -named contractor to do the w prk.stated.
Date
Date 3� 9 7 Notary as to Contractor or Owner - Builder Date
My Commission Expires:
cSei/l
TOTAL DUE a-
Structural Engineer
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITE PLAN
Notes
Site Plan Submitted by'
SIGNATURE TITLE
Plan Approved Not Approved Date
By County Public Unit
HRS -H Form 4015, Feb 85 (Obsoietes previous editions which may not be used)
(Stock Number. 5744 -002- 4015 -6)
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
Page 2 of 3