812 NE 92 St (9)1$
Datel 2 � .-41 Job Address &2' N •F----q` 3 T
Legal Description 277/ Bz/t a Ca ti Co�9
Lessee
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
2 / Tenant 1 l �
Owner's Address VA ` ! ) r I v co 1 Phone la -2011
Contracting Co.l) :f/ lf.PPOYLI cress 1 41 . Iv Y 1
Qualifier34120Y � 4 � 1 �
State # 1 ` 1 « Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor
Permit Type(circle one :UILDING ELECTRICAL PLUMBING MECHANIC" ROOFIN PAVING FENCE SIGN
WORK DESCRI :TION rn •* � +( .
Square Ft. / 4 ;!/ Estimated Cost(value) 1✓ 1c
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO D6
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
au or the ab v -name nt c o to do the work stated.
Signature of owner and /or Condo President
Date
ALinteqembilAbb
Notary as to r 'C,a►dle,Q '
My Comdnil;s' .,f "IMEe;14NO:CO2 .1990
. tie+itr•
► •0 MAY 27, 9533
17 1 . 7... " -- 1 ----- * --
FEES: PERMIT 3 a t. 0 RADON C.C.F. N•ND
** *
APPROVED:
Address
Tax Folio / C7.6
/ A 44 ieg / /3
Master Permit # 7640®
or or • er- Builder
Signature of Contra
Date:
to" ontt'adtde2a ;:.0 � , Builde
sk $I 1' + ieit CGSC•111O
• Cakl
M A 27, 1033
* * * * **
NOTARY TOTAL DUE 3
Fire Other
Zoning Building 7 / / 4&. Electrical
Mechanical Plumbing_ Engineering
A) I-