815 NE 92 St (6)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
(61s Air .Ta s7; 3 J
Date 84, - s Job Address - � �, l -1 r Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant
Owner's Address )15N • Tc .
Contracting Co. 0 W A.I E'
1) a IA1/1 A-igt
Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
; S X' S "T•a
Square Ft. . —c-1/ 2 X 1 . c _12 Q — C
Signature of owner and/or Condo President Date
My Commission Expires:
go
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FEES: PERMIT . RADON
Address
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.
Notary as to Owner and/or Condo President Date g Q.0 tract r im 11, il
y cc� G O6 :NOO TARY STEAL.
2 7-<�, * SANDRA M MONTISI,
''' COMMISSION NUMBER
-t1 e ' CC401261
5 -Y : : MY COMMISSION 3�.X‘'. I
D
C.C.F. rS O NOTARY S: TOTAL DUE jS.
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Estimated Cost (value) ‘ L 7 \ ( . /Gn
ignature of Contractor or Owner- Builder
APPROVED: „ ; *�
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Zoning Building ' / f L Electrical
Mechanical Plumbing Engineering
Master Permit #
Phone
No
(3g23 J-
( -I -
Date
Date