920 NE 99 St (5)Qualifier
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date a" .) Job Address f�/f/ / / '7"
Legal Description
Owner / Lessee / Tenant 4GP/5)
Master Permit # 37t93
Contracting Co. d/
Owner's Address /6 .Ili �9 457; 3/3� Phon 71r5 a3
tIP S Address . 7 �G✓ /s 51-r:
_AA
State #4/ Z # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILD_ G L PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
i
WORK DESCRIPTION /A. ' D� % Gw�l•
Tax Folio
ss# / , Phone
Square Ft. Estimated Cost(value)
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 a d MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is ac urate and that all work will
be done in compliance with all applicable laws regulating constructi -.n and zoning. Fu th; •re, I
autho ize the above -named contractor to do the work stated.
gnature o
Date:
Notary as
My Commission Ex. rr #'s:
* * * * *
OD
FEES: PERMIT RADON
APPROVED:
** *
ndo President
IAL SEAL:
ROBLES
mission ExplrQ$
* * *
S natu
Date: OBLES
on Expires
1996
Notary as to'Ctth'[ • : ct . r or Owner- : alder
My Commission Ex • res:
j2)
TOTAL DUE 30•
C.C.P. g-D NOTARY
Fire Other
Zoning Building Electrica
Mechanical Plumbing Engineering