420 NE 94 St (5)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
1>2te _ e) 'Job Address 420 ? R'7` • Tax Folio 3,0A- (ci Q, 35 ^Q
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant �^
Owner's Address 4 , O ��C -
Contracting Co.
Qualifier e
Address
Master Permit #
Phone 1 759 — 442
SS# Phone 9 75 arm
State #F000ec41/4c Municipal #
Architect/Engineer Address
Bonding Company
Mortgagor
Permit Type (circle one): BUILD t G ELECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
FEES: PERMIT
APPROVED:
Zoning
Mechanical
Competency #
Ins. Co.
No
Square Ft. Estimated Cost (value)
/111021f.
Signature of owner and/or Cond Prdent Date
t otary as to Owner and/or Condo President
My Commissi
Date
O 1P Y PU OFFICIAL NOTARY SEAL
2 m SARINA M HIRSCH
1,. S ' 121 a A COMMISSION NUMSER
- q CC348646
P. €` ®c M YCOMMISSION EXP •
RADON
1'ltunhln,
7
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). :
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 comoiiance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of C,;ntrac or Owner-Builder
•
Notary as to Contractor or Cwner - Buiider Date
My Commission
C.C.F. /c° NOTARY
Building I iiectrical 1
P U B OFFICIAL NOTARY SEN,
2 jtlr `! n SARINA PIA HIRS
t / � . CO pG 4flISS10N NUCH AIBEH
t'�' ,j C 034864
OP W
1.' W1 COMMISSION EXP
1 1
TOTAL DUE 3k
Tngineenno.
1 *? *5 1 c f 4
at..