941 NE 91 Terr (3)Date 6 0/0g Job Address ?// /1/6 91
Legal Descriptiogefl9/ E2OF77 £4'5FTIDT&P5kt Historically Designated: Yes No
Owner/Lessee / Tenant _9,77 s , — L - jQ Master Permit # 7S 16
Owner's Address /o23O /1/..-4= 9/ 7 • Phone (3os) ? � � �/ — 7 , / 33
7
Contracting Co. ES / A �S 7/#e t Address �� s C J war / 14cil
-- Qualifier 4L / , T d'0 � ' 7CAd • SS# Phone 3 S 261-e 3 V
_ State # t�� 0.58 2S2 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION a/ N e-1
e LTA
• Square Ft. 2 7 Z Estimated Cost (value) ., 50a e
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 don- in compliance with all applicable laws regulating
construc on and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
er and/or Condo President
FEES: PERMIT
Notary a to • moTr • r and/o
My Co r Expires:
RADON
APPROVED:
Zoning eZt°
Mechanical Plumbing
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Tax Folio /l 5205 091 0500
oc7- Z/. toes
Signature of Con . ctor or Owner- Builder Date
1 999 zi , sa
Notary r "r o a - S f4 ? Date
My .< r''S ssio
C.C.F. r 60 NOTARY ft
Electrical
BOND 300
TOTAL DUE
Structural Engineer
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