557 NE 92 St (5)Legal Description
Owner / Lessee
Owner's Address
Contracting Co.
Qualifier
State #
Architect /Engineer
Bonding Company
Mortgagor
** *
APPROVED:
as to Owner
ission Expir
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
,1, M72d Tax Folio//50 b / U/
J79 fir./ z .e,5.1'!0
Master Permit 14 � ✓O
Phone 2v , v 2i 5e-t
sue.
Phone
SS
Munici al # — Competency # , Ins.Co.
Address
Address
Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING P ING FENCE SIGN
W RK DESCRIPTION
(1/ i7/ v 5 .17
Square Ft. 7/ 3 Q 0
Estimated Cost(value) ) i
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 AFFIDA that all the foregoing information is accurate and that all work will
be do •mpliance with alp applicable laws regulating construction and zoning. Furthermore, I
a tractor to do the work stated.
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * * * * **
FEES: PERMIT '6 . Nd RADON C.C.F. '5 NOTARY 5 TOTAL DUE
Zoning Buildi
Mechanical Plumbing_
Fire Other
Electrical
Engineering
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRA7TOR OR BUILDER
MIAMI SHORES VILLAGE. FLORIDA
❑ PERMIT N° 6374
B1
Signed
Work to be performed wider this Permit
Subdi .
vision v'
Value of
Project $
DATE
Contractor's
License No.
I! Amount of
H Permit $
195 '
. •
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
' r ,
INSPECTOR
BY
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity wi the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
cepting this permit A I assume responsibility r all work done by either, myself, my agent, servant or employee.
BY AUTHORITY