145 NE 94 St (13)Date
Owner/Lessee / Tenant
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address / c vV E y - s f�
Cos 2 o q-1 / ��leli s _,701
Legal Description
'Fred 11Jtw metvu
Owner's Address PIS` WE / S � • t.)
Contracting Co. ' 1 DTI vE Poi n vE Ser--0I C e s
Qualifier `b i-E Ei n tt 19 1# b
State # E OOOa 0 7 O Municipal #
Signature of owner and/or Condo President Date
C ICE OOOb1' L1
D to Notary
My Co
Not as t6Owner and/or Condo President
My Commission Ekpires' —
MA:.tY LOU BL
II NOrTARY PUBLIC ST:1:':E OF FLORIDA..
II COMMISSION NO. CC472323
Y CO MMISS1oN F7rn. JUNE 141999
FEES: PERMIT 7337 '' RADON C.C.F. ‘)
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Book /t
Historically Designated: Yes No
Master Permit # 3`7 b
Phone 6 S') 75- 7 - /0 73
5a w � 7Os y P141.4 33
SS# Phone 365 -- 82 8 2. ,
Competency # ( kr 0000 189 Ins. Cr ° 3 ✓� 3,
Address
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION RED BkA2 I /4 Ike SyS l�l
Square Ft. Estimated Cost (value) - 1 5 1 0 . '�
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 contractor to do the work stated.
e of Contractor or Owner - Builder
APPROVED:
Zoning Building Electric
Mechanical Plumbing Engineering
Fro -71
Date
o actor or
ssion Expires:
tamer- Builder
OFFICIAL NOTARY SEAL
JULIO R BALADO
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC.S41606
N1 MMISSION EXP. M
Date