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34782PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date °-(7 S, Job Address A300 d JC ,T Tax Folio 1 j J/ 3 L Q© Legal Description Owner / Lessee / Tenant Owner's Address / /.3o J E Contracting Co. 4ir°'.�Y E, L Qualifier -• h SS# - - Phone -° (745 State 'k Municipal # Competency #67,U Ins.Co. 6 Architect /Engineer Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. 'r®o Lur Address ®� (Alit -t) 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 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 informatio be done in compliance with all applicable laws regulating co authorize the above -named contractor to do the work stated. /eh") 1i Signature of owner and /or Condo President Dat -• No as to Owner My mission Expires: cr (3 ** * * APPROVED: Zoning OF R, OFF/CLAL NOTARY C*MMISSIeN NO. C 33 MY COMMON ExP. JULY 13,199P RADON C.C.F. I * Master Permit ,71 / e Phone Inc? -3 770 accurate and that all work will io and zoning. Furthermore, I Signat Dat / Notary as to j acto My Comai sin Expires * NOTARY Fire Buildi Mechanical Plumbing Engineering r or Owner- Builder rr f< Notary P blc ° c, or a " Corf?m ic,a N i a 37 My Cosa i s a , i E r 7196 Bonded Throughilz.Flt.'7.. e,v:c. Hgc,:ingCu } I °[-3 -N '➢r)V }i TOTAL DUE 1 (5 5 Other Electrical