ALARM PERMITDate - 1 Q - 7 $ Job Address 305 O 1 ( ST (eel Tax Folio
Legal Description o 1 13 - t H
S
Signature of owner and/or Condo Prcsidcnt
FEES: PERMIT 3S % 4 RADON
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
2 � t `I
Notare&QwnelpfiBRATIGUARbAsid Datc
My Oen 2 silFeC ``. IR 631227 t o r BONDED THRU
OF P- ATLANTIC BONDING CO., INC.
Owner/Lessee / Tenant A) ct r c y � -e k) Master Permit #
Owners Address 305 9 1 ( sTr ee t-
Contractin Co.
Qualifier N i1ei. r+ (.; 12 . fi n d e r so n
State # F F O LGc) Lo ?- a-- Municipal #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle onc): BUILDIN ELECTRIC PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
C.C.F.
11-32-N) - 3 -4 yci�
Historically Designated: Yes No
Phone - 5Q $ -15 7-Ci L4Q
Address 3 1 g 0 Pg ll
SS# Phone q? 0 0 3.0 0 c9s`
Competency # Ins. Co.
)
S
6 /(
Square Ft. l Cost (value) c71-e1 °
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 arc required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing infonnation 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 Contractor or
Notary as to- Contractor or Owned - Builder
nil" S r CKER
COMMt St C 63
il EXPIRES MAY S, 2001
BONDEDTHRU
OF I - A TLANTIC BONDING CO., INC.
NOTARY
s.
wner- Buildcr Datc
Date
TOTAL DUE $. . -
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering