44102PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date / — �� - 71 Job Address // "3 0 0 N, ) � TaXFolio
Legal Description
Owner/Lessee / Tenant &e#Cft L)// / VfP S l 72 Master Permit # / )
Owner's Address // 3 0 /l/ gri , Phone
P (74 A/c- / mo t / ADC P2. 6 �' Address /‘'‘-i el/ //lam / ���-{ 57
Contracting Co.
Qualifier j Q(ni .S. L.; . 6 , ,/rJ4it)
State # Municipal # Competency #
Architect/Engineer Address
Address
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LIMNING MECHANICAL ROOFING PAVING FENCE SIGN
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WORK DESCRIPTION i< 1 AS 6
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT ,-O RADON
APPROVED:
Zoning
Mechanical Plumbing
Historically Designated: Yes No
SS# � Phone "J()S`°
frDC
2 Fir
Square Ft Estimated Cost (value) /5) 0 °
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.
Signature of Contr tor or Owner- Builder Date
Ins. Co.
DUZ-z-.Z-- d t
otary as to Co or Owner- Builder
My CommisaiVoiptss. s A of M
7) 4F fArq3
C.C.F. ( NOTARY 5 BOND
Date
TOTAL DUE .-S
Building Electrical
Engineering