443 NE 94 St (7)Date
Legal
p
Owner/Lessee / Tenant
Contracting Co.
Qualifier
Square Ft.
WORK DESCRIPTION
3a0
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address `T T3 �l/L q Tax Folio // J %-6 l d i k 0.370
on /q Rik c
J6/
Owner's Address O-C ifu q q-S
7
State # Si '7 ? /I)(O Municipal # /C Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRI AL PLUMBIN ECHANICAL ROOFING PAVING FENCE SIGN
3(90
Estimated Cost (value) 6000
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 law regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do - . tated.
FEES: PERMIT V v RADON
er an or Condo President Da
l03‘
Notaiy aY to Owner and/oF Cond VOTARY t
My Commission Expires: J VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. C(7714103
MY COMMISSION EXP. MAR. 1,2002
0 S
0
Historically Designated: Yes No
SS#
Address
PhonCeJ O 'J 7
BOND
Ins. Co.
ij
l) J)
N.. as to Contra or or 2 2
"e
Commission E Tres: GLADYS J VILIAR
IN� MM ISSIO N NO. CC714103
FLORIDA
l, COMMISSION EXP. MAR. 1,2002
TOTAL DUE
Structural Engineer