1138 NE 99 St (6)� / PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date O l� o / Job Address //38A. 47 Tax Folio
Legal Description _ Historically Designated: Yes No
Owner/Lessee / Tenant (/ /� _ v GC--Zen--- Master Permit # 9 -I b ci l
30,, 7/_,,c_ge,._.
Owner's Address
Contracting Co.
Qualifier
S tate # r -(0.2 7 j7
Architec E i tee "yri
Square Ft. Estimated Cost (value)
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in co
construction an oning. Furthermore, I authorize the abov- nam• ' contractor to do the work stated.
APPROVED:
Zoning
Mechanical
61,
,
4 410/
111117:: Y
F1.CiF!! A
Phone /� e.,.�
T � 7k .S Address [9 Y� /c.J t /c60
/I SS# (�/ / 7honIYP,?
Municipal # Competency #
Address
Address
•• ... -�✓"" "' ..ere
9 sr
6/
r
Si
Electrical
Ins. Co.
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRI PLUMBING ' CHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION C 4 eel O C.c., 7 C /f7
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.
pees:
ce with all a
FEES: PERMIT V O RADON C.C.F. G V NOTARY — V J BOND
TOTAL DUE
cable laws regulating
Structural Engineer
A
• to me well known, 4 wzw
of the above rte d • cow
therein by h statectare true;
Almond of Permit 4
The und
under the Florielsr
plied with the
performed
required, by the Act.
licensod by hamar* Shores r
Size Septic Tank__ Type
Feet of Drain al** or rhain k4 keen
Nature of Water Supply Wet:,
Permit Nc;.,
Application is hereby Rol
structure hereto described
and all provistoas of the La
of Miami Shores Vala
budding dewing peogress e
Owner's Name and Address--
Registered Architect and/or
Employing Phimber's Na
Location and Legal Description
Street and Number where Work is
State work to beprfor
New Building
STATE or FLORIDA,
COUNTY OF DADE.
Before me, tie under
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