990 NE 99 St (10)MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Time
Type Insp'n �— I
Permit No .8 T
Name
Address / /� ! 0 ! vR
Company �r
Phone # /°� (� . / &' 5702 ' / /20
For Inspector: �' (r—E°Z---
Name & Approved , 1
Correction ❑
Re- Insp'n Fee ❑
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address
Legal Description L Master Permit #
Owner / Lessee / Tenant
Owner's Address ? O /// 79 _ phone 7.33/- Z SI
Contracting Co.77ZE7e. Co ( & / / J� Address _ C1 F/2 4J _ I &? _f;>7
Qua lifierSlt)kT )370,Ke4/t) SS# � � - .? 83.phone - 7-C7 77Ob
State# Competency # Ins. Co.
Architect /Engineer
Bonding Company
Mortgagor
Address
Address
Address
Permit Type (circle one): UILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION , ` vV 7 fov
Square Ft.
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. 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:
will be done in compliance
Furthermore, I authorize e
Signa ure
Dat =:
44*
of Owner and /or Condo President
9 / /1. 9) `.'/ ' Tax Folio // g.330
I certify that all the foregoing inforznati• accurate and that all work
with all applicable laws re •• ' ing construction and zoning.
bove -named contractor to do •ork stated.
. f(Di C I •
Not - ry as to Owner and/or Condo P esid
* * Comm sior. E* pines -- NOTR�T 06 EX
• MT COFM Io'S. woo
0NDE0 THRU {;E.lE
PERMIT FEE: APPROVED: 6 Fire
Zoning
Building
Mechanical Plumbing
Estimated Cost
S
Date
Electrical
Engineering
Contractor or Owner - Builder
•
Not as to Contractor' or Owne - Bu lder
My Commission Expires: SIAM
:fit *
�k * $Y T C R OI T �9I IOfl EXt.'1Nit.18�
Other BONDED THRU GENERAL INS. UND.