41749Date S S ` Job Address 1 ®® I .�. ,, Ns. Folio
Legal Description Flistorically Designated: Yes No
Owner/Lessee / Tenant
Owner's Address 1:‘ 3e ® Pvs(C,. Phone q ° 3 g5"
Contracting Co. a e., ? iNt - .‘ Mdress 1,14 ° i ®(5) 4 aa.
Qualifier eS y SS# . - Phone J „3
State # Municipal Competency # 13333ns. cjit4,
Architect/Engineer INC /
Bonding Company IJ f
Mortgagor ,L\
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
I 4' ee
Square Ft. Estimated Cost (value) .c`� 1 9 ®Q . x
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.)
WORK DESCRIPTION
Signature of owner an
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Notary as to Owner an for -Condo
My CommissionExpiresr
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.
esid
FEES: PERMIT r ' RADON
NOTARY TE OF OIDA
COMMISSION NO. CON S675,
MY COMMISSION EXP. AUG. 28,1998
APPROVED:
Zoning
Mechanical Plumbing
Address
Address
Address
Master Permit #j
917q9
7/ .5.1z 7
Notary as to Contractor or Owner- Buelder-
My Commission Expires: MBE ; ,s r�x__. 'rt HY
NOTARY POOLI ATE OF FLORIDA
MAMMON ION NO. CC403675
MY CCrA411, €ON EXP. AUG. 2a,l�
C.C.F. 1. NOTARY
BOND
L
TOTAL DUE 3 6
Building Electrical `
Engineering