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1291 NE 94 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address /.Z9V /"E 99 /,ee7' Tax Folio j ( 3 pl 0 S (J! C. / () / Lot y Legal Description //// i Sip yes , Y/et('Ag y0 , Historically Designated: Yes Noo ,/� Owner/Lessee / Tenant m4ile e fiENR)0 04a AO; 0 Master Permit # Nevie ) .,_ /iy ea , Owner's Address 102-9/ E V SAW'' Ar Sh, Phone 3 s 7s - p- 18 9.3 Contracting Co. r 1(t$-QtD E �1 1 N 71 bJ W R'VIP Q 11 / IJOAddress 1 1 14 F , 62-- Qualifier k) ( C % \ D Q- - ( ) 1 1 A Th t - 5 - SS# Phone a 1--t I gt4 State # Municipal # 30 32836 Competency # ?4.65001 7 9 Ins. Co. Architect/Engineer Address Bonding Com Address Mortgagor an� C/ /? 7€r/ e q Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION C $- NA-'fl Rem t1J \ \ 1 vJ � 1 (J3/1 re -Sh t I 1 ek.S (,c 0c- ~ts E- )ei et can i re) lcak1 W14c r Square Ft. Estimated Cost (value) L (©® efj 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 construction . I certify that all the foregoing information is accurate and . t all wt k will , g. Furthermore I autho ' the above -named contractor to do • wor stated otary as to Owner and/or C. do President Da CommissionE si:) »)'•))7) ,7))77))))) YOB • Roberta Karawan > , .'I Notary f ublic, State of Florida < •.,9. .A Commission No. CC 669954 >< : ?.aM1' My Commission Exp. 08 /06/200 )‹ Bonded Through Fla. Notary Service & 13ondinc Co. FEES: PERMTI''ildill'ii"" .RADON:ri vim,,,,,5 APPROVED: Zoning Mechanical Building C.C.F. Z2/* Signatures =� • My Commission Expires: NOTARY //as, Electrical �x Electrical (MM)£ - ZZ '111M done in compliance with all applicable laws regulating Date Notary as to Contractor ,r er- Builder / Dat > ) ) ) )isYst , )))))»))))i) ?77)))77)))))) Roberta Karawan • ( 1. Notary Public, State of Florida >� \ . , i J Commission No. CC 669954 RS > ''''' My Commission Exp. 08/06/2001 >< Bonded Trmugh F1? * 'Mary Service & Bonding Co. V. BOND TOTAL DUE Y,,2. 3 S Plumbing Structural Engineer