34698APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7'0 Job Address /03Q5 IVt oZ 4 Tax Folio a Z4. ! 5 FJ9ilb'"
Legal Description / L /V -r / k / 1
ref Owner / Lessee / Tenant A FJ Mull;
Owner's Address ) 0 3 1 , 5
Contracting Co. R0b45 �c�a`fi'✓is
Qualifier <S uA > < pcd SS# ' Phone
State # P ° �J 51 S7 Municipal # Competency ,#
Architect /Engineer Address
Bonding Company Address
Mortgagor
o o er and or Condo President
Date: , 1 Q3
A
Notary as t >� Owner and /ori President
My Commission Expires:
NOTARY PUBLIC STATE OF FLORIDA
MY COMMISSION EXP JUNE 13,1995
BONDED THRU GENERA(. I',r�. ns�n,
** * * * * * * * * *
Fire
2,1%.4714 i_
T
Master Permit # , " aft
Phone
Address c / 7 0- op i& cA 61
Ins.Co.
r Address
Permit Type(circle one): BUILDING ELECTRRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION r -- Q - 1 9Qt d+ C.Q. c J O ic,k244 d- "16s In .(,
Square Ft. Estimated 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 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 installati 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 with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Notary ak' to Contrac -• or Owner- Builder
My Commission Expires:
NOTARY PUBLIC STATE OF FLORIDA,
NY COM+IISSION EXP JUNE 13,1995
* ROME* THRU GrANERAL Tt S. UND. *
* **
FEES: PERMIT A®° RADON C.C. i / P NOTARY TOTAL ' DUg= . De
Other
Zoning Buildin Electrical
Mechanical Plumbing_ Engineering