549 NE 95 St (8)ob Address c /!1 E `�/ ° J °S Tax Folio
33138
Legal Description Historically Designated: Yes No
Date
Rosse
s9c/ ik)g /5 i5r
` de° &f �
LhL-
Qualifier L`1 A L /w 77/
Owner/Lessee / Tenant
Owners Address
Contracting Co.
State # L fO000 �p / 3 Municipal #
Architect/Engineer
Bonding Company
Mortgagor
WORK DESCRIPTION
Signature
Notary
My Co
Owner and/or Condo
ssion Expires:
FEES: PERMIT y ..® 60 RADON
APPROVED:
Zoning
Mechanical
6002 0 2)
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Th sfaif 6- ce,42
I - 6071;61o(P - 6°z1/ 6,d
Date
Date
Address
Notary as to Contr
My Commission
C.C.F. • 6D NOTARY
Building Electrical
11 &20,,6 O-7'o
Master Permit # 44 J 7 7
Phone C3 76" 6 .
Address 715 A/ /53 � 33/6,
SS# phone 573 - 3
Competency # Ins. Co.
Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost (value) L / 01 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. F ermore, I a / orize the above -named contractor to do the work stated. r
/ .
Si ture of Co ntractor or Owner -Bui der
ELIZABETH GARCIA
•:
..11 MY COMMISSION # CC 816633
EXPIRES: March 11, 2003
, Bonded Thru Notary Putdlc Underwriters
40
BOND
TOTAL DUE
Date
S - 0o
Date
Plumbing Structural Engineer