340 NE 94 St (11)Date
Legal Description
Owner's Address
WORK DESCRIPTION
Square Ft.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address
Lessee / Tenant W\ Wl(g.M • \ kr � - Master Permit # -3/
4 ' 664
Contracting Co. )L`C ( Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one)'
LDING
noesr st Ne
Notary as to Owner and /or Condo President
My Commission Expires:
;Li 0 Nc . G'i Li 4- k ST
** * * * * * * * *
a
FEES: PERMIT 3u. RADON C.C.F.
APPROVED: Fire
Zoning Buildin
Mechanical Plumbing,
Tax Folio
Phone --/C('-(z r7
LECTRICAL PLUMBING MECHANICAL ROOFING PAVING
(NtyV _./}Aht
Estimated Cost(value) j °°(-)
c) ( -to4sc-
NOTARY
FENCE
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 constructio ... zoning. Furthermore, I
authorize th a e• -named contractor to do the work stated.
Signature o o w n d /or Condo President Signature of Cont
Date: c Dat • " 4
X74 �'7Cyz�e �3 — -
or Owner- Builder
1 MAN eeaTIEl
* COMMISSION NUMBER
•' CC401261
4 • MY CO MISSION •EXP
(* / 1 6F f� * AUG, 17 19
Owner- Builder
SIGN
8 • **
DO
TOTAL DUE
Other
Electrical
Engineering
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