1995 ROOF REPAIR PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date S Job Address ISM N.����3�r Tax Folio a
Legal Dociption lEstorically Designated: Yes a II,,No
Ow e/Tenant M h s . ?0%6 C1.L Master Permit# 3 90 T7
Ownet'sAddress 1 QoQ ►J• E . 1(k3 sr Phone 7S'1 XXIT�J
Cog Co. 3aa,N N W EF-I. t w a Address q x3► N• LL�. 1 S s T
Quaufief -3m A o l 9 E fL L SS# Zq 17M
state# Municipal# Competency# f Ins.Co. ti T
Amlriteer -
Bwdin Canpm Address
Mbrt1w Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROO PAVING FENCE SIGN
WORK DESCRIFTIONA�r
Square Ft. Estrmated 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 EUPROVEAEUSTS 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
regulating construction zoning. Furthermore,I authorize the above-named contractor to do the work stated
S VW i l
ignature of owner and/or Condo PresidentD 1 Signature of Co#tractor or Owner Builder; Date
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N ���yn` p*+���•*r Date ; No as to Contractor ort)n�rWider; ate
My C UL NOTARY SEAL M ommissiam Expires:
�- SANDRA M MONTIEL
COMMISSION NUMBER NOTARY IgML14
* 11991 COM141IS.S%OAY =�"S+'
9, Q to C 4®1 a 81 SO1�D TBBU NOTARY, .
OFF
�Q� My COMMISSION -EXPO.
�'F1 AUG. 17 1998
FEES: PERMIT RADON C. So NOTARY 57 TOTAL DUES
APPROVED:
Zcning RAIX Electrical
Mechanical, Plumbing Engineering
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