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815 NE 92 St (8)Permit No • 6 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Registered Architect and /or Engineer____ Employing Plumber's Name Location and Legal Description Lot Street and Number where work is to be performed —No Amount of Permit $__ A My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT /a -- No. — — - — ...... - -- Street Block-_ Street_ Date Street__ ___ .......... __.___ Subdivision State work to be performed and purpose of building (By Floors)_ _________.___.______ New B Remodeling___ ____ Addition.___ Repairs No. of Stories. Type of Tank__ Capacity Gals Size Septic Tank ........... _______ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Suppl — Size of Soakage Pit ( Signed) _ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by die Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed)_. STATE OF FLORIDA, ss, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida aster Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS INKS SLOP SINKS LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES ...... LIST �y` / J a 7 ( _ 7-- CHECK ����yyy / y� � � � ..i SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL I/!' ggqTTT 4y 1i��Go erek _t 1 3 -- CONTR. LIST CHECK / 9 y� *0°' ,� , ® b'�'HI S� 4 A.,,,1 Permit No • 6 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Registered Architect and /or Engineer____ Employing Plumber's Name Location and Legal Description Lot Street and Number where work is to be performed —No Amount of Permit $__ A My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT /a -- No. — — - — ...... - -- Street Block-_ Street_ Date Street__ ___ .......... __.___ Subdivision State work to be performed and purpose of building (By Floors)_ _________.___.______ New B Remodeling___ ____ Addition.___ Repairs No. of Stories. Type of Tank__ Capacity Gals Size Septic Tank ........... _______ Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Suppl — Size of Soakage Pit ( Signed) _ Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by die Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed)_. STATE OF FLORIDA, ss, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida aster Plumber. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No.___ 6 3 Date__ / ¢ 2 / - Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. a� Owner's Name and Address V 2____-_ - 4 9 2 5 J ° No.__ Street - Registered Architect and /or Engineer-- __---------------- ____ -- - _ Employing Plumber's Name t' r�• « No.___ -3 _6 . _./_._e kit; eet__ Location and Legal Description Lot._ ______ ..... ___...... _ ---- - - - - -_ ___ _ _ Block_ Street and Number where work is to be performed-No. 17..5 .V __ Street Y %L s . State work to be performed and purpose of building (By Floors) __ -_-1 - P.11L- ,_.__4 _SPX _/ /yki. :J2 New Building ____ ___ Remodeling____- — Addition_ Size Septic Tank _ Type of Tank__ Capacity Gals Feet of Drain Tile __._Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City -Well Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and leas com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Amount of Permit $ __- My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING ,MIT __Size of Soakage Pit (Signed)_ (Signed) / ti.e / Cc - e "7 Notary Public, State of Florida ..... Subdi vision ....... --- .__..... ________.._ Repairs No. of Stories. STATE OF FLORIDA, ss, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tuns U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE FIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM•G POOL CONTR. LIST .7l F - -_— CHECK Permit No.___ 6 3 Date__ / ¢ 2 / - Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. a� Owner's Name and Address V 2____-_ - 4 9 2 5 J ° No.__ Street - Registered Architect and /or Engineer-- __---------------- ____ -- - _ Employing Plumber's Name t' r�• « No.___ -3 _6 . _./_._e kit; eet__ Location and Legal Description Lot._ ______ ..... ___...... _ ---- - - - - -_ ___ _ _ Block_ Street and Number where work is to be performed-No. 17..5 .V __ Street Y %L s . State work to be performed and purpose of building (By Floors) __ -_-1 - P.11L- ,_.__4 _SPX _/ /yki. :J2 New Building ____ ___ Remodeling____- — Addition_ Size Septic Tank _ Type of Tank__ Capacity Gals Feet of Drain Tile __._Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City -Well Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and leas com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Amount of Permit $ __- My Commission Expires MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING ,MIT __Size of Soakage Pit (Signed)_ (Signed) / ti.e / Cc - e "7 Notary Public, State of Florida ..... Subdi vision ....... --- .__..... ________.._ Repairs No. of Stories. STATE OF FLORIDA, ss, COUNTY OF DADE. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No Jill Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. /'\ � � / 'i »�/' Owners Name and Address .,::.: - ___ __�__ __ _ tic, Registered Architect and /or Engineer _ (.j __�, ___, ___- _ Employing Plumber's Name_�_s, ____._ Street_. Location and Legal Description Lot_______-_ .... _____________________ _____ Block___ bdivision Street and Number where work is to be performed —No �� e — , Street_ 7 , ` State work to be performed and purpose of building (By Floors) _ Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT of Tank ( Signed)_ Street New Building_____.__ .__________________ Remodeling______ _______ Addition _ ____.. Repairs No. of Stories. Size Septic Tank . Feet of Drain _ �-' f t D at. Feet of Tank or Drain Field from Well Tile_________,_,. Nature of Water Supply: City — Well._____ _..... -- _______.... Size of Soakage Pit Capacity Gals Plumbing Inspector. - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by die Act. The undersigned agrees to employ only such sub - contractors, on rk to be perfqrmed under this - pert t, ,,as are licensed by Miami Shores Village. r -' eV! ''" s° e *° ` ! t& ( Signed Jt .$:. �. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re inspection is made •necessary by improper notice for inspection, or faulty ripl and /or workmanship. GLDSETS BATH TUBS SHOWERS LAVA. TORIES S SLOP SINKS LAUNDRY Tulsa URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK — SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST _�_ CHECK Permit No Jill Date Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. /'\ � � / 'i »�/' Owners Name and Address .,::.: - ___ __�__ __ _ tic, Registered Architect and /or Engineer _ (.j __�, ___, ___- _ Employing Plumber's Name_�_s, ____._ Street_. Location and Legal Description Lot_______-_ .... _____________________ _____ Block___ bdivision Street and Number where work is to be performed —No �� e — , Street_ 7 , ` State work to be performed and purpose of building (By Floors) _ Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT of Tank ( Signed)_ Street New Building_____.__ .__________________ Remodeling______ _______ Addition _ ____.. Repairs No. of Stories. Size Septic Tank . Feet of Drain _ �-' f t D at. Feet of Tank or Drain Field from Well Tile_________,_,. Nature of Water Supply: City — Well._____ _..... -- _______.... Size of Soakage Pit Capacity Gals Plumbing Inspector. - The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by die Act. The undersigned agrees to employ only such sub - contractors, on rk to be perfqrmed under this - pert t, ,,as are licensed by Miami Shores Village. r -' eV! ''" s° e *° ` ! t& ( Signed Jt .$:. �. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re inspection is made •necessary by improper notice for inspection, or faulty ripl and /or workmanship. (TILDING ELECTRICAL PLUMBING ROOFING Owner of Building : Architect Contractor ,' or Builder Legal Lot Description Address of Building .%s" / 5 MIAMI SHORES VILLAGE, FLORIDA ❑ DATE I ', 19 PERMIT N° 6638 Confr to =s License No. ❑ Work to be performed under this Pe r "i- • " CONTRACTC / OR BUILDER , _. B1 Subdi- vision Value of 11 Amount oY1. Project $ ! Permit $ // 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 thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings pr in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed 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 with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac- cepting this perpft I assume responsibility for all work done by either, myself, my agent, servant or employee. BY AUTHORITY BUILDING PERMIT NO. ZONE REQUIREMENTS x Carla Construe' on Co. owner Dors — G. i :: tin4) 815 N. E. 92nd Street. DRAWINGS. SPECIFICATIONS. RESTRICTIONS AND CUBE CHECKED BY: NEW CONSTRUCTION REPAIRS ALTERATION ADDITION OWNER'S NAME PRESENT ADDRESS JOB LOCATION (ST. OR AVE.) GENERAL CONTRACTOR 1634 1 DATE 4 -21 -55 APPROVED CU. FT. SUBMITTED TO PLANNING BOARD NE- SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL REJECTED LOT PLAN CUBE BLOCK 11 P?E30 of 10 1 ADDRESS PERMIT FEES 14.00 16,715 DESCR.P ION REFERRED TO COUNCIL LICENSE NO. SUBDIVISION Golden Ga to Pk Add. REMARKS PHONE NO. NO. DATE CU. FT. EST. COST $ BUILDER'S BOND REASONS CERTIFICATE OF OCCUPANCY NO. a/7 ISSUED _i /9 Bti TO /Vt� BUILDING PERMIT AND INSPECTION RECORD - MIAMI SHORES VILLAGE PHONE NO. LICENSE NO. 10,000 DATE TYPE STORIES ROOF CONSTRUCTION INTERIOR CONSTRUCTION CBS 1 Tile Tearazzo floors, Plaster walls, & ceilings Kitchen, garage, dining room, tern c ; room, 2 bedrooms, 2 bath- rooms INSPECTIONS BATE BY RE- INSPECT BY RE- INSPECT BY FOUNDATION DATE FEE TEMPORARY SERVICE $ BEAMS a LINTELS G ' ;�' 1 g7 $ 6 B07r`9 � SEWER [ FRAMING i $ GAS (° i # 0 i/f ' 40 /s k1 $ INSPECTIONS FINAL !' t'- !�J. BY RE- INSPECT BY ROUGHING CLEAN -UP / �� % ��l / s ''= ,F ° %� ° ,S - C i:�C GAS CONTRACTOR N J _ y�j J PHONE PERMIT NO. /gyp 3� DATE /�,SS �b FEES 7 %s NEW BLDG. l l ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ SEPTIC TANK ' \ ' L. � `_ ---, - 1, .' 1 g7 $ 6 B07r`9 � SEWER [ $ SOLAR HEATER $ GAS $ $ INSPECTIONS DATE BY RE- INSPECT BY RE- INSPECT BY ROUGHING i,f'-C`..- / �� % ��l / s ''= ,F ° %� ° ,S - C i:�C GAS 1 SEWER SEPTIC TANK (0 - ' ' i SOLAR HEATER I FIXTURES ... \ - ' -,. c k;).'4,. ,,. CO' \ (' J.s '\ , -/ . i . _ ..� . ; a' F" < ELECT ICAL PERMITS & INSPECTIONS CONTRACTOR ' \4n PHONE PERMIT NO. aI ® DATE q,_ ', / ' ,-�j FEE $ / ` � (J NEW BLDG. 1 ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVIC .% �/'f $ !�//.3/` $ / �U H. W. HEATER CONN. $ RANGE CONN. $ MOTORS $ FIXTURES $ • $ INSPECTIONS BY RE- INSPECT BY RE- INSPECT BY TEMP. SERVICE ' / DATE .y/ /,S� /n 4 $V ROUGHING H. W. HEATER CONN RANGE CONN. FIXTURE$ & FINAL . , �, , • APPROVAL TO POWER CO. FOR SERVICE DATE BUILDING INSPECTIONS PLUMBING PERMITS & INSPECTIONS BY s . (7, Street Address CERTIFICATE OF OCCUPANCY MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION N? 217 Miami Shores Village, Florida, Owner, Agent or Tenant of Building C Lot /I' L 30 Block _/ Subdivisio Approved use by occupancy Remarks • • This Certificate of Occupancy is issued to the above named for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos. 92, 93, 94 and 97, known as the Zoning, Electrical, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buildings or structures. BUILDING DIVISION Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Legal Description u // P, r p/' 60r /o „elf _/ C� ,/c 67C� Owner / Lessee / Tenant ( 1/QtN ♦ I q- A"� -A/ p' Master Permit # 54/V5 Owner's Address �' cze- Contracting Co. Qual i f i era.,. c& State #/1/ Job Address Tax Folio Phone O / - Address/V0 '7 %7 ( ,,' At (_L V //v SS# / / %Phone r Municipal #fl )412 "v f( Competency # C' ns . Architect /Engineer Address Bonding Company Address Mortgagor . r Address Permit Type(circle one): BUILDING ELECTR AL PLUMBIN i'CHANICAL ROOFING PAVING FENCE SIGN CC WORK DESCRIPTION __���j A :(-- / «0 6-2 e! //7" le92 /4-(' Square Ft. Estimated Cost(valuet g2 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 regulatin: onstruction and zoning. Furthermore, I authorize the above -named contractor to do the work st.'ed.._ Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: ** * * * * * * * * FEES: PERMIT 6 RADON C.C.F. APPROVED: Fire Zoning Buildin Mechanical Plumbin y s to Con actor o Builder My Commission �;t ' STATC * ** NOTARY TOTAL DUE 4.50f Other D �Electrical Lingineering F'tHMl I AF'NLlLAI lUN rUti, MOILlh'ALl I ltJ ur UAUt L,UUNI T Date %1 ; 4 3 Job Address 505 NE 92 Tax Folio (, a ae N1 CA e A-O t v .► Legal Description Lo-t I < Pars of Lo -t 10 ,3 I. o C IL �) Master Permit # Owner WiGAIVNA D A U -E/ fV A Tenant 9 8 6 pEci Day -Time Phone Owner's Address � Co �� - Address ,, /f 1L Architect /E!neer Address Bonding Company Address Mortgagor Address "ntract i Qual if ie State # WORK DESCRIPTION Square Ft. Sworn to & subscribed before me this _ of Jy / , 19 Zoning Mechanical Competency # SS# Phone Estimated Cost Ins. Co. Permit Type: ROOFING BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WAh ING 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 info ti and that all work will be done in compliance with all applicable :ws r :dating c•: tructio. zoning. Furth amore, I authorize the above -named contractor to ated. ignature of Proper'y Owner or Condo Pres. `- ture of C day Sworn to & subscribed before me this day , 19 Signatur of Notary to Owner /Condo President . N.. MICHAEL AEL A. PERAW my COMM Fxp. 7/34 /.96 (Pr 'n K (t ' ',t e;s ,4ya3®prjc nissioned Name) (Print, Type, or Stamp Commissioned Name) Persona Kn / 2:190 Produced I.D. Personally Known OR Produced I.D. l Pener+c'r Won I1WIa 'YPE OF I.D. PRODUCED Signature of Notary to Contractor TYPE OF I.D. PRODUCED Building Electrical Plumbing Engineering