Paint PermitsPERMIT APPLICATION FOR MIAMI SHORES Vyr 7 .
� iz�� NO U(R,
Date f u Job Address Tax Folio `
Legal Description HistoricallyDesignated: Yes
OwnerA=see / Tenant /0� 0 W C - aScP 5�'V • i� 'W 'tz' I P O Master Permit # _ y xa a
Owners Address Phone lqS(0$S7D/6'4�'-03Ay
Contracting Co. / 0\A 1/tl CI
Qualifier
State #
Architect/Engineer
Bonding Company
Mortgagor
Municipal #
SS#
Competency #
Address
Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ' P R t N i Qr
Square Ft.
Estimated Cost (value) / '4 S00 -
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT INYOUR PAYING TWICE FOR EOPROVEMENTS 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 regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Sigt� of -'y • • .
te
Notary as to Win Condo Pr sr nt 'bate I ' Notary as to Contractor or Owner -Builder Date
My Commission Expires: OFFICIAL NOTARY SF -AL My Commission Expires:
' b,.{.�
l TATIANA :N'ASSAR
.,S - �Q ' 1 i o i N�COMMISS ON NO. CC57o17oIPUBLIC STATE OF DA
t MYCOMMISSION EXP. ULY 17,2000
FEES: PERMIT yCi . RADON C.C.F. � NOTARY
APPROVED: } /
Zoning Building `N Electrical
Mechanical Plumbing
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
Legal Description
Owner/Lessee / T,
Job Addressil^ Z ? q t2W l r'l l T�Tax Folio
jj(.0
Historically Designated:
Owner's Address y >! . / p /
Contracting Co. �W � P,i r- ,Nl n0,0,l e16 UCLl'1. Address
Qualifier
State # Municipal #
Architect/Engmeer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING
WORK DESCRIPTION
Square Ft
SS#
_ Competency #
Address
Address
• .FI'4.L-[J
Master Permit #
Phone
Ins. Co.
PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Estimated Cost (value) _:306 • 0 0
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 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 Signa of Contractor or er-Builder Date
Notary as to Owner and/or Condo President Date Notary as is C�ac20 Owner 1° J VIILLAR"
�n/l YS
My Commission Expires: My Commissi Exp es: NOTARY PUB11C SLATE OF ELORI
COMM6.SION NO. CC7[4103
MYCOMMISSION EXP. MAR 1,2
FEES: PERMIT �/ RADON C.C.F. + ( 0 NOTARY •00 BOND
TOTAL DUE
Zoning
Building 'C i Electrical
Mechanical Plumbing Engineering