SHUTTERSPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date t Job Address 970 NE 92 Street Tax Folio 11- 3206 -06 -01305
Legal Description 6 -53 -42 AMD PL GOLDEN GATE PARK PB7 -54 LOTS 16 & 17
Owner / Lessee / Tenant Owner LOUISE H. GAINEY Master Permit #
Owner's Address 971 NE 92 Street Miami Shores, FL 33138 Phone
Contracting Co. HOMESHIELD INDUSTRIES Address 3585 EAST 1 nth rMtlgT
Qualifier JOHN NICKEL SS# Phone
State #11111MMINIMMONMunicipal # Competency # 0444 /S 3 arns .Co .
A91 -2888
Architect /Engineer J . V . KNEZEVICH & ASSOC_ Address AM MnKFNA DB IVE
Bonding Company Address
Mortgagor NBD Mortgage Company Address P.O. Box 331755 Detroit, Mich
48232
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION STORM SHUTTERS DADE COUNTY PRODUCT APPROVAL 91.0903.1R2
Square Ft. 321 Estimated Cost(value) $ 4,500.00
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
autho4ze he above named contactor to do the work stated.
Signature of owner and /or Condo/'President
Date: 6 - °19 4.- 93
Notaryis to Owner and /or Condo President
My Commission Expires: r- _g 6
APPROVED:
Sign
Da
or or Owner- Builder
ry as to Co tract'r or Ow n _er- Builder
Commission Expiresk,"A;o°.'
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**
FEES: PERMIT RADON C.C.F. NOTARY ,
DUE 7-
' r
Fire , _ Other
Zoning Building/ Electrical
Mechanical Plumbing Engineering
STORM SHUTTER WORK TO BE DONE
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