87 NE 92 St (8):L. ea G sgCf •
/W ,
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address lJ 7 / y , ? Tax Folio // 4 / 3 t,2. /O i
Legal Descri tion x (3 (g 2n 6 i/
Owner / Lessee / Tenant Master Permit # 4 1/7/9
Owner's Address f/ We Phone � 3 � n
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Contracting Co. (_' Address / 4,L N 1,'u ' f ( D 2/'i F b
Qualifier 6. 2f‘i�l, SS4t ' Phone `. 0
State IP f?..K 06 & - Municipal # o6 DOC ZSDC Competency IPG' rO Z �Q e Ins .Co. e
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING' ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION
WARNING TO OWNER: YOU MJST 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.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
Ld' t 7.,LGG�
** * * * * * * * *
FEES: PERMIT ,4 C.C.F.
APPROVED: Fire
Zoning Buildin
Mechanical Plumbing_
Estimated Cost(value)
Signat re of Contractor or
Date: • //3/9
tary as to C
y Commission
•
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r 1 • %116i,
C� -.ter'' J �Cf✓YJ20'�� �?�
TAL
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Other
Electrical
Engineering