541 NE 94 St (6)4 -
Date - gf°
WORK DESCRIPTION
FEES: PERIN/IIT
Legal Description
Owner/Lessee / Tenant
ARO
otary as to Owner and/or Condo President
My Commissio
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address l n 2 g V AG Tax Folio 1/^ 3,W 6 — 0/V— OS 7
Owner's Address 5
Contracting Co.
Qualifier
State # �Q CAS Municipal #
/
Square Ft. Estimated Cost (value)
Sign ure f owner and/oVCgtido President Date
d
4a % ! Master Permit #
Phone 7J5 - 2— co cz()
, nY PL OFFICIAL NOTARY SEAL
O r , r-rte -6 S ARINA IA IBRSCH
2 H IV y `�jI » COMMISSION NUMBER S !!, 1 0.0348646
IN / OOrARA1136ION EXP
gFf W :•
RADON
Date
C.C.F.
Historically Designated: Yes
No�
3 s �
Address
SS# ,�� hone `7 c �j 5
Competency #
Address
Address
Ins. Co
Architect/Engineer
Bonding Company
Mortgagor ` Address
Permit Type (circle one): BUILDINNECTRICAL LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
/G6C
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 re : 1 ' g construction and zonjng. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contractor Owner- Builder
- /4 • 4. -# .4 ._.
• or • wner- Builder
nROI9'fet,, OFFICIAL NOTARY SEAL
F� 1 / �� C1 'JHNINA 4N hiNSCH
@ ?: rc +F. C Opa61C48 NUMBER
ete F � w►ISSION EXP
1.r Sri
otan as to C
My Commissi
NOTARY
TOTAL DUE * 41,iaa
APPROVED:
Zoning Buiidtn.: Electrical M.
Mc chanical Plumbing Engineering
Date
Date