571 NE 94 St (10)Date r
,/r
Legal Description
Owner / Lessee / Tenant l�, ,,,,A, �d ! �'
r/
Owner's Address
Contracting Co* / f )f� •�f.' r� (Vi !//
Qualifier SS#
State # Municipal #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ; ) /4- /4// /1i, ,9 /*
Square Ft. Estimated Cost(value // /l 3 l
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
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address j // "/ Tax Folio /1 .1.1 (6 / q e9d
5 3
sr �l e 5'f"
Si*ature o owrfei / and /or C on Preslaent
Dote : / J'
/11, cUI���ei �VA4
Notary as to Owner ardl
My Commission Expirec:
'-: JOSF:PFI ?'E CHURCH
*: i!t &lr P;! lc, • S+,te of Florida
ndr ( Ptb!s idigifirfrli 30. 1996
q c•';.•
No. CC137545
* * *
Competency # ez P Ins.Co.
- - Phone 6 y - 3 - 3 4 '
be} 14 /lc)
FEES: PERMIT 3 RADON C.C.F. /it
Fire
Zoning C Bui g"
Mechanical Plumbing
Master Permit #
Phone
73 .g /
Address ( 3 4 /)! l
Signature of Contractor or Owner- Builder
Date: j'/ 9=3
ary :s to Co
My Commission E
*
NOTARY ":D 6 TOTAL DUE J i 5-6
**
Other
Electrical
Engineering
i /4..4 �L.
BUILDING f
ELECTRICAL
PLUMBING
ROOFING
Owner of ,�/ '` �t I
Building c �1r4 t ( , e• /l V C' / t i
Architect
Contractor
or Builder e -t. C■• ,_ ove-
Legal Lot
Description.
Add of r
Buildi ng J 7� / r q 9
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
pertaining to the work covered hereby whether shown on the plans or drawin or in the statements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
In consideration of the issuance tq..me'6 this permit I agree to perform the work covered hereunder in compliance with allcordinances and regulations
pertaining thereto and in strict cosaardity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village.
In accepting is per is it responsibility for all work done by either, myself, my agent, servant or employee.
PERMIT IT? 11639
Work to be performed under this Permit
MIAMI SHORES VILLAGE, FLORIDA
DATE / " ! / ' r / 195
Bl.
psoLt
Subdi-
vision
BY
Contractor's
License No
Value of Amt. of
Project $ Permit
Signed: BY
IN E R
AUTHORITY