PAINT PERMITPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address
1168 NE 9 sT
Legal Description t Z 4 7
/ Lessee / Te1p, /VON 57 .7
Owner's Address , /V6 q /.ST' phone (1069 7SY- 95 /
Contracting Co. dtlli(/be /�/J / Address
Qualifier SS# - - phone
State# Competency# Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING„j ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION �j¢j;‘07/ WooF Cub4
Square Ft.
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. 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 Owner and /or Condo President
Date:
Notary as to Owner and /or Condo President Not
My Commission Expires: My
PERMIT FEE:
APPROVED:
Zoning
Mechanical
7 el,Pailleri
Fire
Building
Plumbing
Estimated Cost
Sign•
Date
f y a( to Contractor or Owner - Builder
commission Expires : NOTARY P : LIC STATE OF FL ID*
* 7 F* MY C' • SION EXk OCT. 27.1,93
BON _ J HRU GENERAL 1 S.
Tax Folio/ J/1/ /
Master Permit # lad /
Other
Electrical
Engineering
re of C.7 ractor / r Owner - Builder
Date
ignat
Date:
** *
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
�' 2) �.Tob Address / ' Y 7v. 9/-s S Tax
Legal Description
Owner / Lessee
Owner's Address
Contracting Co.
Qualifier n/
FEES: PERMIT
/
Architect /Engineer
Bonding Company
Mortgagor
Notary as to Owner
My Commission Expir
/-07 E 1 4 g
Tenant U A £ T ja TL
4 CAL., Address
IV
SS#
State # Muni ' al #
resident
P06 OFFICIAL . NOTARY SEAL
ei' SCOTT W' DAMS
V'
* COMMISSION NUMBER
CC255237
*MY COIIMISSIOIf EXP.
OF F'L JAN. 26.1997
RADON C.C.F.
Phone
Competency #
Folio 1/ .1P0/ / 00 70
oci6 7 EL Po72rc c_
Master Permit # 364) 70
Phone ( S) /S1 7877
Ins.Co.
Address
Address
Address
Permit Type(circle on C UILDING EL " TRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION I 7 EX 1 .I rY Q c Pt W H I
Square Ft. Estimated Cost(valu ( C
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 -name. contractor to do the work stated.
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
NOTARY
1
* **
TOTAL DUE i
O
Fire Other
Zoning Buildi :r� 1 Electrical
Mechanical Plumbing Engineering