37024Date ta'281qy Job Address
Legal Description
Owner / Lessee / Tenant
Square Ft.
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APPROVED:
/Soo
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
/ (3 al N.ty-
k `n- CtP / Co t4- —
Signature of owner ndo President
Date:
Notar fs to Owner and /or Condo President
My Co ssion Expires:
FEES: PERMIT ® RADON
Mechanical Plumbing_
Estimated Cost(value)
Tax Folio ( ( 2 ( 36 00 00 u
37a
COI I �G, Master Permit # ( 3 ‘ 63644)
Owner's Address_ ( 314/14 '1 69(14 -c>< I i 3 k) IA- 2 -Ave — Phone
Contracting Co. A AA Cci"4 ( ` i 1 !L oc0 4 �� � � Address ° l P4-4/ .2 ».-
Qualifier e-* - C- AC A SS# hone Cd 5z 95
State # CC CO( 017 Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING, ELECTRICAL PLUMBING MECHANICAL ROOFIN T PAVING FENCE SIGN
WORK DESCRIPTION 0- eL0J0 o 0 4 o f a,- re L7
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.
S % = ure of Contractor or Owner- Builder
ate:
Notary as to Contractor or Owner- Builder
My Commission Expires:
C.C.F. el NOTARY
Buildin
Y TOTAL'
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Other
Electrical
Engineering