825 NE 92 St (10)Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor
Job Address/ g z /1J r 5t Tax Folio % / — 3 2.06 -
Date
Legal Description ,�y�
Owner/Lessee / Tenant / ' S/ / °1
Owner's Address }( 9V/0/ / 8 f Jcr Q L I/O - AG en;
i f kiu j
Contractin Co.k f D ,- —1 D le P. Address
1/8
, eA,,4
Notary as to ( - ��•+ : _,or 'resident
FEES: PERMIT J{) RADON
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
0 43
APPROVED:
Zoning Building
Mechanical Plumbing
Historically Designated: Yes
SS#
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION X O e 94. E'er 5 () C7 ',J.:4
Square Ft. Estimated Cost (value) `' / 2, sot)
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.
Sign1ture of owner
Signatur • _ Contr
/14 •
Not as to Contrac
C.C.F. NOTARY
Commission E
Master Permit #
Phone( 7 5 ? — 6 ''tI
D5) 5 - 96�E
hone
Electrical
uJ, 4 -N
Ins. Co.
r or Owner- Builder
er- Builder
06 3
No
YU,'P
NOOTF.R. FuB IC �•TAT5 C): 6F ?.Ei ilf1A
� �1.' dJ:.i1J�4 .''0. CCfr!73357
Date
BOND // / ;
TOTAL DUE `Tf!E/i' >�/
Engineering
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