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34588
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date ��/ �� Job Address /1300 N6 .2+'a Legal Description Owner / Lessee / Tenant Bi}aP- (, N d fe2S e rz Master Permit Owner's Address Phone Contracting Co. 6,4s 4909-5r Qualifier /'deer_ 6. 14Aierel 5 State #ECOb Municipal # Of,- 4S ?competency # / /D6 Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL ;PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN - rain PO e4 -try I W6i2 6AsS7 ri °41 WORK DESCRIPTION Square Ft. a� E st imated Cost value) 3 Db 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 indi 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 MECHANICAiL 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 regulatin_ construction and zoning. Fu thermore, I authorize the above -named contractor to do the work sta -d. Signature of owner and /or Condo President Date: Notary as to Owner and /or Condo President My Commission Expires: Zoning Mechanical A tie. SS4# / Phone Address 8750 5c4. 324,0 5 T mit4in) 3 ©5 - 213 - 0o 1 Dat • Tax Folio j/ 01'g lP "c' 'IV, Ins.Co. APPROVED: Fire Other gnature of Contractor or Owner- Builder ` ' RY PU®tltl 17 0 1 a oltiNNtr i ider err cT: �': e0F • AfAi N•j/ary as: o Contracto My Commis "ion Expires: tltlAP d OFF14`IAL NOTARY SEAL ** * * * * * * * * * * * * * *IDGETT C.1*.P ** COM ISSION NO. CC293977 MY CO ISSION EXP.10,1997 PEES: PERMIT 3 RADON C.C.F. NOTARY TOTAL, DUE t Building Plumbing Electrical Engineering