179 NE 94 St (5)Legal Description .2 a ° ag
IFERMi III' AIP LTI CATIION FO IVIIIIAMII SHORES VF LILAGE
Date 1 -2093 Job Address 179 NE 94 STREET
Owner / Lessee / Tenant HAROLD JONES Master Permit #1
Owner's Address 179 NE 94 STREET MIAMI SHORES 33138 Phone 757=9091
Contracting Co. NORTH DADE SEPTIC TANK Address 800 NW 111 STREET
Qualifier DENNIS NEVILLE SS# 267 _ 94 - 6375 phone 754 -3375
State # 0258368 M un i c i pa l # Competency
# 12842 Ins.Co. AFCO
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION INSTALL DRAINFIELD
Square Ft. 300 Estimated Cost(value) $1000.00
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 %n compliance wi h all applicable laws regulating const on and zonin Furthermore, I
autho.• e the above -n jd contractor to do the work stated.
12Y /
S'gnature of owner ind /or Condo President Signs f Cont ctor o Owner - Builder
Date:
Date :� 1
No ar.' as to Own/ a d or Condo President
My Commission E •fires: NOTARY PUBLIC; STATE CE FL072UDA 6!T LMEMGS
MY CO W,ISSio7I r"t ?Ii zs SiR:: ➢ ), 17.'5
EONJE.) THRU I:UCKLL:IEF.::Y & ASSOCIATES
N
My
FEES: PERMIT 30110 RADON C.C.F. . ,..5 NOTARY TOTAL DUE ( 54
APPROVED: Fire Other
Zoning Building • / ' Electrical
Mechanical Plumbin_ J Igineering
Tax Folio /1 jrg O /..7 2/w f
41:2
as to Con for Ownb ecua,,l�rAn,.
ommission E
• ssusuc, STAT'
tar
Gi.Y Co MISSICI4 E.Jt ?I;iiS SUNS 14, 1795
BONDED THRU t ?UCKLE BRRY & ASSOCIATES
u a
MIAMI SHORES VILLAGE. FLORIDA
lUILDING ❑
DATE 195
1.ECTRICAL ❑
'LUMBING
P]EI�MIT No 9428 Contractor's
License No
GOOFING ❑
)wner of
: uilding
.rchitect
: ontractor
T Builder
.egal Lot
)escription
address of
• uilding
❑ Work to be performed under this Permit
Bl.
Subdi-
vision
Sq. Ft
Value of
Project $
Amt. of
Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
rawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
me if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further upon which this permit is
ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
.!rtaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he Assumes responsibility for work
one by his agents, servants or employees.
Signed • BY
1 INSPECTOR
In consideration of the issuance to ,je of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
rtaining thereto and in strict confbrmity'with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
i accepting this permit I -. assume responsibility for all wpt ne by either, myself, my agent, servant or employee.
i" ,- _ < t/
CONTRACTOR OR BUILDER 1 BY AUTHORITY