965 NE 92 St (9)Square Ft.
Date g Job Address 5 N q2 ' 1 Tax Folio
40 r_® P414c term -b / ` storically Designated:
Owner/Lessee / Tenant nJ C56 G - C. 1 � ( - Z
Legal Description
Owner's Address q66 -1 2_ a T Phone 7 Cq --- 460 8
Contracting Co. c j iM — ITt CiiV O / 77 t Ailldress e t pr ffiv q1 7-5-ft.,, 12"1
/j
Qualifier P—�- FU L-G ss# �. S+Phone �(�(J 7 '- q 6` 14
State # q.6 4-6 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ECHANICA . ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
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 co : , tor to do the woxlyst:
FEES: PERMIT
Signatur wner and/or Cdo President D
Nru + Owner an
My Corn4ssion Expires
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
r 7o
.417g /do President
JUAN PEREZ
COMMISSION # CC 431785
EXPIRES JAN 27,1999
BONDED THRU
ATLANTIC BONDING CO., INC.
RADON
ate
Estimated Cost (value)
Notary a
My Commission Ex
C.C.F. 1 NOTARY
3206 -066 0 ®1
Yes No
Master Permit #
I7rcroo
JAN PERLC
Sz MISSION # CC 431785
fin'. EXPIRES JAN 27,1999
�', : �O BONDED THRU
tyf „ '' ATLANTIC BONDING CO., INC.
TOTAL DUE
Date
APPROVED:
Zoning Building Electrical
Mechanical 1 Plumbing Engineering