87 NE 92 St (5)Date Job Address/ / /i/g 72 ST
Legal Description / Historically Designated: Yes
Owner/Lessee / Tenant?‹ 4/vGIlee v✓ A 1' a
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Contracting Co. ` :. - - •�:.� ____��.L
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor Address
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Municipal #
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
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WORK DESCRIPTION
Square Ft. Estimated Cost (value)
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 tha e foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zo ermore, I authorize the above -named contractor to do the work stated.
or C undo Presid
Signature of owner an
9,319*
Notary a Owner and/or Condo President ate
M Com n ssion a I
1 CO'LC '
FEES: PERMIT 40 • RADON
t
Date
APPROVED:
Zoning Buildin
Mechanical Plumbing
C.C.F. 160 NOTARY
Tax Folio t I t
Master Permit #
Phone
SS# Phone
Competency # Ins. Co.
Address
a 0
of Contractor • ' er -Bu's . er
Contractor or Owner - Builder
Notary
M Expires:
FOFT,
g.
BOND
TOTAL DUE
'3.13 Icts-
Date
G Electrical
Engineering