384 NE 94 St (5)D le e A i O -?_.3 Job Addres4 3 4 /U � q 4 5/ Tax Fo1io0 11 - la a) -013 4, t go
Legal Descriptio)( //MMll ,Sii/0 &L Ef1'- 1 M4 e g Lois 1 Ta 4 „ti gL LU7° ,s(2...( .
,20-0.0-00 )0 i orc Q`�oq e- 1 i 3 /
/ Lessee / Tenant RoaciI � / y¢U&S V.L, IcAfo t) G / /fl/d Master Permit #5
Owner's Address - g A.; ,c Q4 ST12 -ES fi ` Shs= ie( Phone ?5q" V q(4,
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Contractin • .I1 0 1 .'. ., " ,� Address /2,, it ti) 02,v2 .91)
Qualifier 4 ge SSa - Phone �p?/) 11
State 41: Municipal # Competency # e X / Ins.Co.
E PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL
WORK DESCRIPTION '- /C1 e; T / (1465 ./► of
�0 [ G, • /-4 s 7,1 e cf �-f ftSS f/ c ik
Square Ft. /224',/ 6-4% 9. ;D5 i Estimate ost(value)
WARNING TO OWNER: YOU MUST RECO A TIcEOr OMMENCEMENT 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 trade 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, PL 1 G, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
hem foregoing information is accurate and that all work will
p ic-•,1e 1 ws regulating construc and zoning. Furthermore, I
rac o to d. the wo/k stat
Sig tu• ilder
Da /'
//
OWNER'S AFFIDAVIT,: I �tify th t all
be done in cpnl nce wit 11� •
authoriz�.�tfie : •ove na l a co t [
G
r and /or Cond
Signature of owA
Date l/0— ( &
APPROVED:
Presi
ent
Notary as to Owt ,yanc Apr, pndq,.Rt<Q, ;j4ent
My Commission ER fi lP:,SiO cx?.,
, :fV0 THAI GEJtM;_ :( S. UND.
Fire
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Mechanical Plumbing
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of Co
tor or Owner-
tr *1d>QBi : l•
MI? UiLIC STATE • r • ' b: MISSION NO. CC2U9 21
MY COMMISSION EXP. UNE 1:3399a
otary as to C.
My Commission D. ,
1
*
PAVING FENCE SIGN
A e / flu/4mi -)
a " .�c�
*
*
*
FEES: PERMIT 0.40 RADON C.C.F. (4 a 00 NOTARY TOTAL DUE 9
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Other
Zoning Building Electrical
Engineering_