40495Date
PERMIT APPLICATION
i Xor ION FOR MIAMI SHORES VILLAGE
10- 6.14 J o b A d d r e s s 1 V W Iv ► Ian u o
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant IN A49 1 IV y Vas
Owner's Address 1 00 hi Milton A u e
C o n t r a c t i n g Co. W 0 0 7 `14 I S Sal V 6 GIB
Qualifier NI dpgal G so pt)
WORK DESCRIPTION
�• Ry�loR
ignature of owner and/or Condo President ' ate
Notary as to Owner
My Commission E
FEES: PERMIT /t9t- RADON
APPROVED:
Zoning Building
Mechanical Plumbin
G
tolgto
Master Permit #
Phone
Addres a ) 7 N E. 31, 67*
ss#
Square Ft Estimated Cost (value) 12 CC 00
37
Phone 5((Q 1 2.0)
S t a t e # OR. . Ac b 10 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
54,404/I 9 20►ve5 - t- Rolf
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 regula construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
)14.444 4. Mitz ou lab -96
Signature of Contractor or Owner- Builder Date
Notary as to Contr
My Commission
LINDA C. VERDI
STATE OF FLORIDA
1 l7txp 3- 8-1998
t�wnaat gnu
Sim yp
Date
C.C.F. NOTARY BOND /(a
Electrical
TOTAL DUE
Engineering