550 NE 94 St (13)Js
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1
Owner's Address 5 U E 1 s
Legal Description / I �
Owner/lessee / Tenant J on
Qualifier
State E
Architect/Engineer
Bonding Company
Mortgagor
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Contracting Co.
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FEES: PERMIT )-®e RADON
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ct
11111WAREnt
` ddress
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Permit Type (circl one): BUIL 11 MECHANIC
WORK DESCRIPTION . 161r) I 1
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Square Ft. Estimated Cost (valu�•
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
ING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
•
ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
ermore, I authorize the above -named contractor to do the work stated.
2 4 - Tax Foli 1 l32c ,o ` q oq `I o
Historically Designated: Yes No
Phone X 51 - / 0 `
Address G ' V L3 IC ,
PhoneLn V 0(
Competency # Ins. Co.
Address
Master Permit #
Signature of Contractor or Owner - Builder
ROOF G PAVING FENCE SIGN
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Notary ae o 2bRMinffi6 g
My Cohmissionttt' J; Ma Z eM7
IL= CimiLvdwgx ;.
C.C.F. NOTARY BOND
3)2-
Date
Date
TOTAL DUE
Building Electri
Plumbing Structural Engineer