485 NE 94 St (5)Date
151
Legal Description Historically Designated: Yes No
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Contracting Co. M4ff\
Owner/Lessee / Tenant
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
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Notary a• o •r °•`r
My Commission ` xpires:
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j,, • �► PUOU4 . OF FLORIDA
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FEES: PERMIT 7g/ ° J RADON
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Master Permit #
3 ( Joy
Phone 1 1Q — 4
Address D � g e ii f.- ow 1
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L- \i \1 110 La f- Aural
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.
OWNERS 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. Furthermor-, I a thorize the above -named contractor to do the work stated.
Notary as to Co
My Commissio
ATE OF FLORIDA
Signature of Co _ - Date
Date
C.C.F. ' NOTARY TOTAL DUE J Jt p �
APPROVED: �(/{ �f j�
Zonin g Building Electrical ' t zv/
Mechanical Plumbing Engineering