DRIVEWAY PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date l / 7 Job Address . fl 1 1 i ■ f/ .-T Tax Folio // -- &l a O /41 - D 3 0
Legal Description l-97---
r9 / le d- V(F o ) ! j�C //i'/ Historically Designated: Yes No
Owner/Lessee / Tenant "`� i#/'/e1 Master Permit # 4 / 5 7, ,
Owner's Address o `" re Az e . J . Phone 'P Sac- ° ' S / 7
Contracting Co. 6 S 7 7 / ''V (4''4i,FI L" Address
Qualifier S# Phone
State # , / MMuniicipal # Competency # Ins. Co.
Architect/Engineer /�Lj1l�'t/ o 0/T0/E3
Bonding Company /
Mortgagor Address
Permit Type (circle one): BUILDING EL
Y CTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /?&&'\' Os sh4) 6-6/1-1
Address Mad Ai deco /68' gr.
Address
Square Ft. (4- c X L (, Estimated Cost (value) 4410
00,6 0 ( Foal< )
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.
4% I
Signature of owner and/or Condo President Date Signatur91o Contractor or
7 /9 - y
Date
Structural Engineer
SITE PLAN
SCALE: r 2a - 0 f
NE 3rd. AVE
EXIST. DRIVEWAY W/
BRICK PAVEMENT
ON COMPACTED SAND OVER
COMPACTED GRAVEL
co
co
w
z
11.11.1011111.001PCIR&S,
° DRIVEWAY BRICK
PAVEMENT FOR
CHARLES
HARPER
RESIDENCE
AMISS
WM UAL OWL R.
Yw ROIOL
am
OW= EIMPI2
TEL 000) 701 -0096
SHEET 01DE(:
• SITE PIAN
VCR actin r . 44d
WIPC4 .
am am arm emu.
OM bZT w.
T/If/M ,
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 5-77-5-419 Job Address c2r I AL E: - /
Legal Description L/ /4c9 a 3 //i7- Ada ,, a 6 / f
Owner / Lessee / Tenant ��� Tp t I S ! u fr L( (
Owner's Address C990 NC 9/ 5'i Phone ‘
Contracting Co. ®d Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION I? /11
Square Ft. n
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
FEES: PERMIT
,si ui��
Tax Folio 3 °3o /v/ 3/5-f
Estimated Cost(valu ff"'D
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.
50
1
Signature of Contracto or Owner- Builder
Date:
Notary as i to C
My Co 3(.ac Qi a
** * * * * * * * * *
RADON C.C.F.
APPROVED: Fire
Zoning Buildin
Mechanical Plumbing
*
NOTARY
Master Permit # : 3p47
lYV �'
Sf BARBARA ANN FUGAZZI
� ;,� COMMISSION NUMBER
$t FA CC360191
MY 20MMISSI2N EXP.
*e OF W MR. 291998
0 TOTAL DUE I J 4o
Other
Electrical
Engineering