27 NE 94 St (18)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Datc /0 'Z?- 97 Job Address _ 02 0 NE 91 S, Tax Folio
Legal Description o (- t S / (P/ Limey
/ /C/a IgOAIA
Owner/Lessee / Tenant
Owners Address / / E rf y .S I
Contracting Co. /
Qualifier M e. - f--, n Q. • A el Je_f-- e S r
State # eF0 o b 0 Lo a 'a- Municipal #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILD ff
WORK DESCRIPTION 1 va /CG.e /9 0_
//- 3.7 - 013 - a S ki0
Historically Designated: Yes No
Master Permit # 4 -4 2 07 ,-
Phone - 7 S7- 8 / S
Address 3 7 4e,
SSII Phone C--- 0 3 °
Competency #
Address
Address
Address
Ins. Co.
PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost (value) ° ��
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 wrni 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 regul ng construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
c of owncr and/or
Signa
Not,,ty 4.1 tVarituotant6er ll'Otidcnt Datc
r +� . yp 4 D 5, 001
My� j +,'srOn I DEDTHR
O f 1\. ATLANTIC BONDING CO., INC.
FEES: PERMIT ? r e:1104 RADON
G¢(,rrw /0-ay -%1
o ndo Presid Date Signature of Contractor orOwner- Builder Datc
C.C.F. t Qv NOTARY
s u, ;h 90:742PACkwner -B ildcr
f Ys4S�1RiE> cs$31227
^` q e XPIRES MAY 5, 2001
9 J� BONGED THRU
Of FN- ATLANTIC BONDING CO., INC.
APPROVED:
Zoning Building Electrica
Mechanical Plumbing
Engineering
TOTAL DUE'
Date
60