40494PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date \0.. ' tQ Job Address I t 3 d0 IdtTaxFolio
Legal Description Historically Designated: Yes No
P�13r�r�y YU Gr
Owner's Address ' j O0 1 V hlYtant
Owners / Tenant
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Master Permit # W09 ( Pi/
Phone
Contracting Co. Ui g yl -k,) , . well r 6 d ' , J Address 1� ' A c I
Queer t V / 73 I 0 ) J TOM-- SS# ph 414/
State # 0 / 5 0 Municipal # 1 1 4 0 Competency # f 1'3 C) >— Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL '' LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
it
WORK DESCRIPTION ., I "I + ` l.10€
Square Ft. Estimated Cost (value) 14,6
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
INSULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WTTH 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, ''• nstruction and zoning. Furthermore, I authorize the above -named contractor, : o ; e work stated.
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nndo President Date
LINDA C. VERDI
STATE OF FLORIDA
My Comm. Exp. 3+1998
a
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Notary as to 0
My Commission
FEES: PERMIT
Commission CC 354019
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9 -14 ld _
APPROVED:
Zoning Building
Mechanical
e
C.C.F.
Signature of Contractor or Owner- Builder
Notary as to Contr
My Commission Erp'
Lti•1
NOTARY
LINDA C. VERDI
STATE OF FLORIDA
Exp. 3+1998
Slnpiston Hutchinson Winoo
Commission CC 354019
. 4 41 1, V 1- 6 1
BOND
TOTAL DUE
Date
Date