1997 ALARMDate Job Address . Al` 1'49 Tax Polio
Legal Description_
Owner / Lessee / Tenant AA/fi1 L. a i., Master Permit 1i L /af
Owner's Address So b A1 ‘ 7 O 93/5er Phone
Contracting Co. '-/ H A s d /A? Address ...5 f *4i /.1 5
Qualifier ,( l /ales -I i,;eG.r SS4 # Phone 5 R - C 2 '.S
State it Ef" a 27�nicipal # Competency ii Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one BUILD E 'TRI PLUMBING MECHANICAL ROOFING PAVING FENCE SIG
WORK DESCRIPTION
Square Ft. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO D
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEN
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, are
on the attached addendum (if applicable). I certify that all work will be performed to meet tr,
standards of all laws regulating construction in this jurisdiction. I understand that separat
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 ork wil
be d•ne in compliance with all applicable laws regulating construction .nd z'ning. Fur . rmore,
aut orize the above na.:: co - or to do the work stated.
igna re of owner and
Date:
0 .
Notary as to Owner an
My Commission Expires
** *
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
or de Presi
,
Ai
JULIO ROBLES
MY C^MMISSIOP 0 CC 560034
Doodad tt4 UndMWdtom
Signature of •ntractor �;;"� B ilder
• Date:
Notary
My Comm
*
* *
FEES: PERMIT. ' / 4 V RADON C.C.F. ,P.2 NOTARY TOTAL DUE 3 r, ‘4
APPROVED: Fire Other
Zoning Building Electrical!' i ',W 5 '
Mechanical Plumbing Engineering