474 NE 94 St (11)Date .-//40/e3
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address L 7 114 91(5/ (5 /
1 •K 4 e S
Legal Description Lod 3 4,a. 44 f 4s4 'I L i LA 1 areal 57 •I .NsiS Ac.# • /.Im�
/ Lessee / Tenant ^ yie. 7.44 N 06) Master Permit #
Owner's Address (1 7 y N e 9/ 5% Phone 7,5n= -7/i-2--
A « ` n
A
Contracting Co. c 5 F.pi Address 7 73 .4,44/ Z ` S Ad 4
Qualifier b4 14-44-4.21 . 5 SS# Phone 7 b
Tax Folio 1) 51 «` , $/ 9
State #42$ 00(. /l7I Municipal # Competency # 0000 81° 'Ins.Co.
Architect /Engineer A)O '. Address
Bonding Company Address
Mortgagor SQA 25 /1 Grf P Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING IGN
WORK DESCRIPTION ' -C+ di ('4 V .2 3 3 6,4- 7)
`SquarFt. Estimated Cost(value) �y• sr)
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 411 laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S
be done
autho i
APPROVED:
AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
in compliance with all applicable laws regulating construction and zoning. Furthermore, I
the above -.amed contractor to do the work stated.
Si ture o o e` and /or Condo President
Date:
°`" "' Cam./
Notary ato Owner and Condo President
My Commission Expires:
NOTARY PUBLIC; STATE OF FLORIDA AT LARGE
MY COMMISSION EXPIRES SEPTEMBER 26, 1993
* BONDED ED THRU AGENT'S NOTARY BROKERAGE
FEES: PERMIT .3o0 RADON C.C.F. APO
Zoning
Fire
Date:
:4-e+ i4)4414 34k s
f Contractor or
CCU
Notary as Contractor er- Builder
My Commis on Expires:
NOTAR PUBLIC; STATE OF FLORID AT LARGE
MY COMMISSION EXPIRES SEPTEMBER 26, 1993
* * BONDED Riau AGEN'S NOTAY BROKEIIOB * **
NOTARY TOTAL DUES /B°
Other
Electrical
Mechanical Plumbing Engineering