1158 NE 99 St (3)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ')(1S)1 Job Address (1 S 1\) 91
Legal Description L A M � tOC\L I ` ) ` j � V \ynA S110KS 5 .. E • I (3 - ( Ig
Owner / Lessee / Tenant f'VaN1L a \‘.,i(IN) 0 R4.V2 Master Permit # 36,C'0/
Owner's Address \ � � 9 N , �. c % 5.1 Phone }
Contracting Co. � ,1- r. Q0)(1 Ind Address 160c PJ.W '79 M (�hc,�lc�.,I clavt6
Qualifier \^i(v1,1101 SS4t Phone S r ))./ / )
State #M0d6W1 Municipal # Competency 4P I `l 41 Ins .Co . CAIAIS CC)
Architect /Engineer soh►J 1Ctile.2e VICArN Address b 1 v1a11e IO 01 &coil Spv-u v s
Bonding Company Address
Tax Folio l is 3105 0(302-
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION 10 S(AN hc:rlr.g 4- . i - •OVm QckhI`15 1oy 1 tv &t u, ICIV■tvC)
Square Ft. ).6
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
autho 'iz the a ove -nam d contractor to do the work stated. 0,4-kSvnSN PQNCL 1Nc, (
gym`
Signature of Contra t or finer Ru~iIder
Date: -) AZ )1
Signature of owner and /or Condo President
Date:
Notary as to Owne
My Commission Exp
** *
FEES: PERMIT N
APPROVED:
Zoning
7 /
u
� U OFFICIAL N• A o AL 0
ti BARBARA ANN FUOAZZI
`i=t * COMMISSION NUMBER
e Q CC360191
� 0 COMMISSION F*(P.
n<<t MAR. 29,1993
RADON C.C.P.
Fire
Buildin
Estimated Cost(value) 1 q0C:). 00
* * *
f, ,
tlaib
-
a� 3
. w111111rr .
O OFFICIAL NPTAR StAL
� p BARBASIC"A'ia*OGAZZ}
+ * COMMISSION NUMBER
Q CC36oifg1
, p MY Cq 4U BXP.
OF FlO MAR.
Notary as to
My Commission
NOTARY
Mechanical Plumbing
TOTAL DUE
* *
Other
Electrical
Engineering