705 NE 92 St (7)FEES: PERMIT 3v RADON
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address/ ? Pr E q . C. Tax Folio
Date
Legal Description
Owner/Lessee / Tenant
�
Owner's Address 1 c)
/Z ),
Historically Designated: Yes / No
Master Permit # 4 ,aD
5 r-
010/1a ddress
ss# . -
Phon < j / C /
Phone) _`_7 Y 1
Qualifier
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost (value)/ 2,„. 0 U .
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 work stated.
. / ? _ 2Lf /
Signature of owner and/or Con President Date
'New yorI( STJ D 23- ,fS -8c9: / - ,t000
Notary as to Own' i b ,:,r.► ►^;r. 7.7 My Conut fission Exp l se•D 1 VIL ' '
NCrARY'."J;:LIC STATE OF . j
C`Jt?\+IZ;;Ioi i NO. C " ' 4 J3
MY COMMISSION r.XP. MAR. : , 1
Building
'S ignature of
Notary as to ' ontra' ' . oi:." 7 : 7 ".r. !1' ARY SEAL
My Commission E ires: GL.ADYSJ VP..? AR
1`s 1RY 1 U(it cC SPAT". OF LOF U f
cOMM5SION NO. CC 714103
f.OMM{ !C1\LEXP MAR.IWA
C.C.F. /. 7—Q NOTARY I ..-- BOND
Electrical
--r4. 47 ' 5 —P
or or Owner - Builder Date
Date
Plumbing Structural Engineer