875 NE 92 StPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ( 7 y Job Address fir:` ) •T Tax Folio // ° .3ZQ06
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Legal Description : ° 20. .3 E Z. ea ° Historically Designated: Yes
Owner/Lessee / Tenant
Owner's Address C - 3 S
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Contracting Co. .% r i.;j
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Signaiur -o ?owner and/or Condo President Date
LUIS GARCEU.
FEES: PERMIT �-) RADON
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Cry'`
I1 x My Commission CC418105
7 � i Expiros Nov. 01, 1000
Notary as to Own r,,Conds01468 i> P ate
My Commission Q L Se'a :11
Address
Square Ft. Estimated Cost (value)
Master Permit #
Phone
Aq
Notary as to C s ntractor
My Commission Expire
Gc 5 - o Ct
Qualifier Al i ll ,A4r 4 — J° y' SS# . " - ? - Phone -
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION V '
S
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.
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Signature of Contractor or Owner-Builder Date
"
caner- Builder Date
C.C.F. . 43is NOTARY TOTAL DUE : 3,770S
APPROVED:
Zoning Building Electrical
Mechanical
No
Plumbing Engineering