431 NE 94 St (7)Date
Legal Description
Owncr/Lassce / Tenant
Owner's Address
Contracting Co. ? 0 DTI Z �'c� -
Signature of
11 1,(10100
wner and/or C do President Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 43/ AJ 9/ £ r Tax Folio
`A 6L4 J p ZEE - S C
t 2, ( e L
4301 Ale 9c¢
del
otary as to Owner an I or Condo President Date
My Commission Expires:
Y PV Maria Pd. Hernandez
�� ®�, Commission # CC 769d413
AIL" 6
, z Expires OC1. 7, 2002
f, BONDED :Tay
OF 0 u wrIC BONDING
FEES: PERMIT 5 U RADON C.C.F.
APPROVED:
Zoning Building
tr 3 aoG o(L o4
Historically Designated: Yes No
Master Permit # O
Phone .r 3 2.2 o o
Address 39'o D alL)u.) 70t A -v. N o �( 71._
Qualifier l""4 Z- f 4P-lb 124 SS# Phone Ca :0 3 ') B4c1.
State # QC.9ol) G ZZ Municipal # Competency # Ins. Co.
Archilcct/Enginccr Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION g '- `Z- L 4- jtA. ibtAA .lrk�
a
Square Ft. Estimated Cost (value) 2-
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 mcct the standards of all laws regulating construction in this jurisdiction. I understand that separate
permits arc 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 do the work stated.
Signature o Contractor or Owner- Builder
Notary as to Contractor or Owner- Builder
My Commission Expires:
NOTARY — o
Electrical
P Maria N. Hernandez
. a Commission ## 769413
•11) P. ¢xplres OCT.?, ME ice" P BONDED THBIi
OF E1, ATLANTIC BONDING CO.. Mt
r !:'r v
])ate
O
TOTAL DUE . �D
Mechanical Plumbing Engineering