45 NE 94 St (9)•
Date Gat / "Job Address
Legal Description
SO", V-05
Owner's Address 4/0 9 dl s
Contracting Co. r -r-/2/ 7 CGS
Qualifier 's y C )V
State # J 9 / /
Owner/Lessee / Tenant
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING P G FENCE SIGN
C ✓�-��"-
4/4))
WORK DESCRIPTION
Square Ft. Estimated Cost (value)
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.
V
Signature of owner ,ondo President
-Notary as to 0
My Commissi
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION
3
Municipal #
r and/or Condo President
Expires:
• OTARYSFAL
MICHAEL ALAN CLARK
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC751622
M N EXP.
FEES: PERMIT . ®e RADON
SS#
Competency #
Address
4
i lje , v/ 615
O z /47D 0
Date
Date
Signature of Contractor o
C.C.F. 60 NOTARY — 0 " TOTAL DUE
Building
FOR MIAMI SHORES VILLAGE
Tax Folio ►1 - 3206— 0 k3 — 0S
Historically Designated: Yes No
Master Permit # & c.( k✓
Phone 3O.f - 7.15 7 IS? L7
Address e r7 y .1/ 12S1/6 ,
Phone
Ins. Co.
N'. ary as to Contra or or Owner - Builder
My Commission . pires:
0 NOTARY SEAL
MICHAEL ALAN CLARK
d OTARY PUBUC STATE OF FLORIDA
COMMISSION NO. CC751622
:MY COMMISSION EXP. NE 15
- Builder Date
Electrical . � -
Date
Plumbing Engineering