374 NE 95 StMr. I 1.
Date `L 2 • 3 Job Address 3 7 Nat- 7 - Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant Cp c / a,v)
Owner's Address 3 74' /vr 9 5 r
WORK DESCRIPTION /*"?
Square Ft. / c)
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
'
te ~o President
My Commission Expires: #r:/
FEES: PERMIT ►° RADON
APPROVED:
Zoning
Mechanical
C.C.F.
Building z%
NOTARY
Master Permit #
Phone 7.S ' S -///0
Contracting Co. Si /2 3 C Address ( 3 0 Q ;S 7' J'p). pi-A/45
Qualifier 7-9l2J, / S SS# " Phone te,":2 f-3 ,- 7
State # Municipal # E ®2 e w Competency # 1 Ins. Co. S22 7 r ' O f
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
txx) T C,' 7wvz /7 4772 / Y�
VV/ 7/9 ��c' f 41/ C ®r /7J.,X ,- jbelw6 7
Estimated Cost (value) lS 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.
•
Si t. : e of Contractor or Owner- Builder Date
,otliaAa vxv,46
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner-__ Date
My Commission Expires';
Electrical
TOTAL DUE "0 '
Plumbing Engineering
i W
379 / v
5 ! /72ir9. 5/ c
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37z ilx 5 s r
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BUILDING
ELECTRICAL
PLUMBING
Owner of
Building _
Legal Lot Bl.
Description
Address of
Building
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N? 3754
Architect
Contractor
or Builder
Subdi-
vision
Work to be performed under this Permit
Value of
Project
DATE 194
Contractor's
License No.
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 herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance
with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may
be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition
upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of
the ordinances and regulations pertaining 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 done by his agents, servants or employees.
Signed: By
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula-
tions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper autiiit it hies of Miami Zht s)
s u
Village.. In accepting this permit I a me responsibility for all work done by either myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY
AUTHORITY