PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date �' � i Job Address zoo. -�- 9(9 Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant l`1 ) Gdi 1 p...) e Master Permit #
Phone 7n- z"
_%3 . Address 090 N yv /(o / 2± / /e ._
Q ualifier Gerpt'LJ SS# ®( e23Phone3cf9p:7c9fr e
c
State # C e0 �7Q(oo - Municipal # Competency # Ins. Co. 0?,L- F� 1 �°
Architect/Engineer 3 �i' Address
Bonding Company Address
Mortgagor ► 4 A Address
Ownees Address .MO2 NE, 9
Contracting Co. e, GC- S -e r J I C.-e S
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
fl I;04 ( Cte
WORK DESCRIPTION
Square Ft.
/
WARNING TO OWNER: YOU MUST ? ECORD A NOTICE F 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 done in compliance with all applicable
laws regulat construction and zoning. Furthermore, I authorize the above -named co act•, to do the w► s' +ted.
t
/1 / a
of owner and/or Condo.President
Notary as to or Condo President Ya
My Commission E
NOTARYPUBUC - STATE OF FLORIDA
TONY GERACI
COMMISSION # CC603309
EXPIRES 1248'2000
BONDED THRU ASA 1- 888- NOTARY1
FEES: PERMIT 40 e O RADON
Date
Estimated Cost (value)
C.C.F. � b NOTARY TOTAL DUE 41. ZO
APPROVED:
Zoning Building
Mechanical Plumbing Engineering
1
i' t.�L` r te • _ .•
Signature of Contractor or 0 r� er -B lder / D
otary as to Contractor or Owner- Builder
My Commission Expir : V PV OF ►L �T ARYSEAL
A RACE U ACOSTA
n
comussicsi m9
4 CCO2027#
MY 00 10N SWIMS
FEB. 20,2001
98'
'�ctrical
A LL
auied
a)ea
asea
# /aweN Joioo