375 NE 94 St (3)PERMIT APPLICATION FOR MIAMI SH(
Date -3aw0o Job Add 5 A e R q Tax Folio
Legal Description Lo7 i 1 3 ( W . 2.0 Gl O3 Lot 14 L Historically Designated:
�
Owner/Lessee / Tenant ,1P /11 S and Jam le t11. 134 k) M i
Owner's Address - 515 - it) g q Y �/'I,2 Q . 1t4 (0-S60-4 Phone
Contracting Co. ow Address -39r 41-
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor t C43 h t/V( WA JU
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1 a- pa /VJ JPA (�2 (3 h Qy/t_Q_ `(-'aJ /S T14-- - /4 pvuu .d�.
oa ord c , � - 4c/U U
Square Ft. Z. 2 O 0 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 WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain 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 e work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date Notary as to Co
My Commission Expires:
FEES: PERMITS� RADON
APPROVED:
Zoning
Mechanical
Building
Address
My Commissi
C.C.F. , D NOTARY 3
�S�S�CS N (v7 /
E
Electrical
4 50. -c / 5
4 ►
ignature o i ontrac . Jr Oar Builder
j S 3- 6 1 -///-1,
,
• 11..$i - :u1
. fires: OFFICIAL NOT ' Y SEAL
GLADYS J VIL.LAR
NOTARY PUBLIC STATE OF FIXI:ZII)A
COMMISSION NO. CQ
MY COMMISSION EXP. A.1
a
v
Date
BOND
TOTAL DUE 3
Plumbing Structural Engineer
36.
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