818 NE 92 St (10)• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Owner / Lessee / Tenant Iced /WR /M 7'm /l (/& '/' C Master Permit #
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Legal Description St
Owner's Address
Contracting Co.
Qualifier CUIn
State #
Architect /Engineer Address
Bonding Company /" e/ ..ddress
Mortgagor a 1, L tS ,ff/ 4462.709 Address
Permit Type(circle one`: BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION fiK Cw4 -t.S /N 0021CL cEiu &'t 1 "*%W X!.-06 K 7tCf
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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 compli: with all applicable laws regulating construction and zoning. Furthermore, I
authorize the e-named contractor to do the work stated.
Signature - oil owner and /or Condo President Signa
Date: 1 7/ - / — C/3 Date:
** * *
FEES: PERMIT
APPROVED:
SS#
Municipal # Competency #
iv/
Notary :s to Owner and /or ndo President
My Co': ission Expires:
* *
RADON C.C.F.
Fire
Zoning
Mechanical
Buildi
Plumbing
Phone 7. 5 '19YY
Address S 4 :( J9 OV
Phone FV VY
Ins .Co. "
Estimated Cost(value)
CFFkC AL NOTAi Y SEAL
/2
frAq I'U � / �� 7 ��PLORIDA
c( l`Y1M1SION NO. CC236952
MY .OM1141SSICiiq EXP. NCV. 28,1996
r- Builder
Notary as to Contractor or Owner- Builder
My Commission Expires:
NOTARY TOTAL DUE 1r l
Other
1 17, Electrical
Engineering