40 NE 95 St (4)BUILDING
ELECTRICAL
PLUMBING
RG9FING
Owner of
Building •"›
Architect
Contractor
or Builder L `
Legal Lot
Description
Address of
Huilding
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
DATE > - 195
PERMIT N? 5112 Contractor's d
License No.
/ c: , l
Work to be performed under this Permit
Bl.
Signed.
Subdi-
vision
c9 v�
Value of ri Amount of
Project $ 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
!rawings, statements or specifications that may have been submitted to and approved by the proper :municipal authorities. This Permit may be revoked at any
ifine 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
,ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
3 ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications a t he assumes responsibility for work
lone by his agents, servants or employees.
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 regulations
3ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac•
epting this permit I assume responsibility for all work done by either, myself, my agent servant or employee.
b l BY LR—
AUTHORITY
1
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date. 2 5 " Job Address 4 1 0 F 9 <5 ' ; Tax Folio ! /'
Legal Description 4'1 Si. /6 Ai /121 6 5 t, . Historically Designated: Yes No
Owner/l ee / 'Ffitipt f e :3A M S 1t
Owner's Address Is/ Y 9 <� ' L - Phone 7 . `� 4 '
Contracting Co.
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION X PAT �,_ rE (2 7 o-2 o f
Square Ft. Estimated Cost (value) J^
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.
0
Signature of owner and/or Condo President Date Signature of Contractor or Owner - Builder Date
l
Notary as to Owner and/or C
SEAL
My Cormin lohnin}r NOTARY
l !eAN1RA M MONTH,
O c _ onj SStON NUMB&
• �, � CG4012
COMMISSION .EXP.
171998
;I9
Municipal #
FEES: PERMIT RADON C.C.F. ° IO° NOTARY
APPROVED:
Zoning Building ' ( '"C' :Electrical
Mechanical Plumbing Engineering
SS#
Address
Competency #
Address
Address
Master Permit #
Phone
Sao
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
Ins. Co.