80 NE 92 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date vl "c,�s Job Address e t, 1, Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant rl 1.R \ o 'i \ h
Owner's Address
Contracting Co. e%
Qualifier
State # Municip
Architect/Engineer
Bonding Company
Mortgagor
My Commission Expires:
APPROVED:
Zoning
Mechanical
Building
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
Barrister
FEES: PERMIT t 0 RADON C.C.F.
Phone ( - 33S 7S L - SR
Address
1)
Electrical
Master Permit #
Phone
Ins. Co.
Permit Type (circle one BUILDING)ELECTRICAL PLUMBIING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION `,C e 4
(11� �LIAA� (A,9 A C .mcF>
Square Ft. Estimated Cost (value) y 1(O C .o 0
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.
OWNERS 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.
nat f ontra for or Owner - Builder Date
-; rc
tary as to Con ctor or OligaetOWdEiLLAR
My Commission E sitreARY PUBLIC STATE Or FLORIDA
COMMISSION NO. CC7I4103
MY COMMISSION EXP. MAR. 1.20x.!2
NOTARY BOND
1 2 e7; TOTAL DUE ` 1('
Date
Plumbing Structural Engineer