1998 PAINT PERMIT PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date I I I 1 z g 8 Job Address I I`T 3 N.E. 103''( Si- TaxFolio -
Legal Description I hstorically Designated: Yes No X
P Owner/IAMM/Tenant �,n nr wr E 0. F e S C.H l=2 Master Permit#
Owners Address i I-13 &1.eI ogrd S,1- Phone -75 8- 908 Z(r,) 3y 7-i6S,4 Z(w�
C --Cc. Irl JA 0 Address
Qualifier SS# - - Phone
State# Municipal# Competency# Ins.Co.
Architect/Engineer Address
gig Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORKDESCRIMON 1:-AF-. 'RAiNT:K& TRE OUTSc0E OF MY 14OUSG'
square Ft 23 0 Estimated Cost(value) SOO �a.�►+ * s.,,Qpl;tS>
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
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 authorize the above-named contractor to do the work stated.
Signature of owner and/or Condo President Date Signature of Contractor or Owner Builder Date
1111.34
as to Owner and/or Condo,Precedent hate Notary as to Contractor or Owner-Builder Date
My Commissilgo�liqpires: My Commission Expires:
susma MOW
My Conmdmion 00692713
E)q*es 0jr,06,2000
FEES: PERMIT l/ / RADON C.C.F. V NOTARY -^ O f BOND
TOTAL DUE
APPROVED:
Zoning Btulding !� � Electrical
Mechanical Plumbing Engineering