45 NE 94 St (26)• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ,` —/ t Job Address "Ic 4(6 9' r Tax Folio 1 1 - 32 OF®- 0 I. 3- 0 S5)
Legal Description
44 11 crg S ro3
Owner's Address L iC No 9 ( .
Contracting Co. -cs
Qualifier V . ; y C ss#
State # ES / 9 / / Municipal # Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING P G FENCE
WORK DESCRIPTION
Owner/Lessee / Tenant
4 604-- t
( 3
Square Ft Estimated Cost (value)
FEES: FERMI
APPROVED:
Zoning
Mechanical
Historically Designated: Yes No
Signature of owner r ondo President
of owner r ondo President
• OTARYSEAL
MICHAEL ALAN CLARK
NOTARY PUBLIC SPATE OF FLORIDA
COMMESION NO.00751622
�• MISSION EXP. 15
D z7 /1/0
Date
Notary as to 0 r r and/or Condo President Date
My Commissi• Expires:
RADON
Master Permit # 6 7: 2- `1 ' /
Phone 34S' - '7S 71 17
Address 1 7 7 y sr / ✓'
Phone
Ins. Co.
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. Furthermore, I authorize the above -named contractor to do the work stated.
ire
Signature of Contractor o' - Builder
SIGN
Date
Date
Notary as to Contra or or Owner - Builder
My Commission pires:
O NOTARY SEAL
MICHAEL ALAN CLARK
• NOTARY PUBLIC SPATE OF FLORIDA
COMMISSION NO. CC751622
MY COMMISSION EXP. NE 15
C.C.F. ► tP 0 NOTARY 0 " TOTAL DUE
Building Electrical ��2 T/ - / 0,- ` °9
Plumbing Engineering