1291 NE 94 St (8)PERMIT APPLICATION FOR MIAMI SHORES VILLAAGE
Date 5/ 5 Job Address /2 7( A/6- 9S / Tax Folio / / 320E lilt
1 I 0 I'
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant ` , (C Ie. 1() r / Master Permit #
Owner's Address 12-q q ) r E � Phone 1 oi-noi J
Contracting Co. Vies Address-1 i (c) I
SS# Iphone-7()`-qQ [O(,
Qimlifier ' t 1)iQr z f - )2
State 1 Il G 4 Municip #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING
WORK DESCRIPTION -�L
c gnature of owner an
President Date
4
Notary as to Owner and/or Condo President Date
My Commission Expires:
Competency #
Address
Address
Address
Ins. Co.
PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
010 )reaer ± 105
Square Ft Estimated Cost (value) 20K 5 .
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 AFFIDA certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating co •n and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
FEES: PERMI7 �� ' ‘ 947 RADON C.C.F. r (D 0 NOTARY
Signature of ontractor or Owner - Builder
APPROVED:
Zoning Building Electrical
Mechanical
Civ
Notary as to Contractor or Owner - Builder
My Commission Expires:
, ,«T
BOND
TOTAL DUE
Date
/ 95
Date
/3itrb) �5
Plumbing Engineering