85 NE 94 St (14)T V / PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ,f A 4 / aob Address n e , Tax Folio / / o -- 0 1 5 -- ()5 gO
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Legal Description (--04 aa- i ?-8 (o Ll L' Historically Designated: Yes No
Owner/Lessee / Tenant }-Vt)i I') J mCc GL1 Master Permit # &( /
Ownees Address 8S n E q Phone - 15 - 7 - cog a 9
Contracting Co. /)1 04 1 Address
Qualifier NO Y1 �c,a,
State # CFOOO 1 off Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor _ Address
Permit Type (circle one): BULLDEN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION L2) W (JO
SS# Phone 01 - 3°23 3 L5P
-gegrai SS's r ce51, v
Square Ft. Estimated Cost (value) 9/ • °C'
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 done in compliance with all applicable
laws re - . lating construction and zoning. Furthermore, I authorize the above -named • • e wor; stated.
e of owner and/or Condo P
t
as to O
y Commissi. Exp
er and/or Condo President
FEES: PERMIT 3Ls RADON
tlao le?f
ident
D
ate
es: OFFICIAL NOTARY SEAL
CRETTER ALFONSO
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC522853
MY COMMISSION EXP. )AN. 7,2000
Si
My Commission Expires:
APPROVED:
Zoning
Mechanical Plumbing
Building
Electrica
to Contractor or Owner - Builder
Date
Date
C.C.F. n c NOTARY BOND
TOTAL DUE SS .
Engineering