1092 NE 94 St (12)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address / 2- ? '� '' � Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant -- /Z � ' Master Permit # (T5 5-r 4/73
.
Owner's Address c) 2/ `� /✓ Phone
s -.
Contracting Co. �/Z GG I r ~ Address
Qualifier /7 - / li SS# ,.? / /�� Phone
State # C _. °21 ' 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 /95,-� ---f —B: �� ��
/% / l -cam D'� G/1 4; P Ce /
Square Ft. Estimated Cost (value) <V
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.
OWNERS AP'P'IDAVIT: 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 . bove -named contractor to do the work stated.
d/or Condo President
Signature of o
s to Owner and/or Condo President Date
mmission Expires:
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON
to
C.C.F
�ynPrj iiilder
GLAD'S j VILLAR Date
OFFICIAL NOTARY SEA
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. L2002
NOTARY ./ BOND 4/taki
ri
TOTAL DUE ; 5
tractor or
scion Expires:
Electrical
Plumbing Structural Engineer