38034 (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date e t - 26° C 15 Job Address 1 �� 2ND A'E Tax Folio
Legal Description
Owner / Lessee / Tenant . 8A 4 1 - ( t :IFleS (1 -- TAMAtsPce7Al) c3 4 Master Permit #
Owner's Address Phone
Contracting Co.
AYt.1 -tip ( PL3M'laAC -, bi MIAMI cI C ess2,6 - )1 5 i.1E Ito PL NJ M !3
Qualifier " 1V 1 mai-> k% k SS# Phone Cost ° X31
State iteceOtRifiZMunicipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL 4)11k1. MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION \t4S;1" s Sipes A tt.„‘sy__`t,)(„ ®`�
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 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 stat
Signature of owner and /or Condo President
Date:
Zoning Buildin
Mechanical Plumbin
Signature of
Dat
3000.
ctor or Owner- Builder
OLY Pie
Notary as to Owner and /or Condo President Notary as to
My Commission Expires: My Commission ExpT`res:
** * * * * * * * * * * *
FEES: PERMIT RADON C.C.F. NOTARY ° TOTAL DUE_3211
APPROVED: Fire Other
*
er
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Electrical
Engineering