474 NE 94 St (10)3 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date 9 a 7 Job Address 1 4 0 C 1 1 1 ' > } Tax Folio
Legal Description Historically Designated: Yes No X
97 2y - Yrc-7/Y)
Owner/Lessee / Tenant J 0 Sf �) 1 Q 1'z
9 •) y tv t
Owner's Address
Contracting Co. / -1 R C `S S
Qualifier
WORK DESCRIPTION
otary as to Owner and/or Condo President
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Sign: = of own =.' and/or ' . do President 1 ate
D•te
$'OFFICIAL NOTARY B; 2 7 77
ei SANDRA M MONTIEL
i. COMMISSION NUMBER
CC401261
7 ,. cr. MY COMMISSION EXP.
OF 0. MM. 17 1998
RADON
APPROVED:
Zoning
Mechanical Plumbing
Building
ei
C.C.F.
Master Permit #
Phone ) S6 / a
Address l /!,i /la Ge%,
ss# , Phone 6 7g s
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL TG MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. E stimated Cost (value) SOD
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.
Signature of Contractor or Owner- Builder
Notary as to Contractor or Owner- Builder
My Co
O .0P93 Pli OFFICIAL SANDRA NOTARY
2 w x COMMISSION NUMBER
4111 , < CC40126
� O MY COMMISSION .EXP.
® .� U 1_ 1998
. 60 NOTARY S •
Electrical
/ / J
Date
Date
BOND 30
TOTAL DUE •14l/e '
Engineering
•
APPLICATION FOR:
b( New System Existing System 046 Holding Tank p Temporary /Experimental
2 / , ] Repair [rJ andonment (�✓j Other(Specify)
LICANT:
AGENT: .
MAILING ADDRESS:
TO BE COMPLETED BY APPLCANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
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PROPERTY INFORMATION [IE LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED)
LOT: Al BLOCK: SUBDIVISION: DATE OF y
,v SUBDIVISION:
PROPERTY ID #: [Section /Township /Range /Parcel No.) ZONING:
PROPERTY SIZE:
PROPERTY STREET ADDRESS;
DIRECTIONS TO PROPERTY:.;
BUILDING INFORMATION [ RESIDENTIAL
Unit Type of No. of Building
No Establishment Bedrooms Area Saft
4°Z
2
3
4
STATE Oil FLORIDA
DEPARTMNT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE IEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, *8 & Chapter 10D -6, PAC
D EL
[/'1 Garbage Grinders /D4sposals
[!✓] Ultra -low Volume Flush Toilets
APPLICANT'S SIGNATURE:
REORDER FROM APEX BUSINESS FORMS
rat.I J
( s) .6.17— 7 t •
a h . 33241.
ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ J PRIVATE 6/1 PUBLIC
97y A / E • f f )L
[ J COMMERCIAL
(/./1 Spas /Hot Tubs (p4 Floor /Equipment Drains
[ ] Other (Specify)
PERMIT #
DATA PAID
FEB PAID $
RECEIPT 0
TELEPHONE: 756-7/7,2-
# Persons Business Activity
Served For Commercial Only
DATE: 04