870 NE 92 St (12)Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address yg7o 7 i ' • 924.e. Sr Tax Folio
Legal Description Historically Designated: Yes No
/ Tenan t ,/A 5 • ' O /•6 Master Permit #A 6.3 2 /
Owner's Address 170 714 - 7 Z Qc .T• Phone/ 305 7S " 255
Contracting Co. 5/4 tit d - 111 - C- . Address IL ,(_��- ;c -, S
Qualifier 7 ) � P LOtMJSS# - Phone 7) —" W) [/ segiv
State # Municipal # Competency # q sgsC CC;,5 s. Co. to ()4, d 00 ,14
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOF G PAVIN
WORK DESCRIP'T'ION ILA 4 ( b e �r , 2 4J
V' J. AL � IA + ti- Le e ki
Square Ft. S Estimated Cost (value) ,
3L0
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- narred contractor to do t he work stated.
Signature of o
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My Commission �,*'. ' a.; ' ]2C SY,AYS Cllr Zi s7`A
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APPROVED:
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Zoning Building
Mechanical Plumbing W'*
Electrical
Date
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BOND
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Date
TOTAL DUE 7 �
Engineering
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