PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address L 1 Y, r7 /IV Tax Folio J/ ��,� e --49E-347 r
Legal Description e/ P' 0 t`.;(f ( fill 44z-it Avwe 4'0,0~
46y / Lessee / Tenant Z/& 'F22O9 7' ? r, j , Master Permit # 3
Owner's Address 2 4(, /Ve 77 ✓/ / 4 A�✓ Phone %C %
Contracting Co. da
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL , PLLUMBING MECHANICAL � ROOFI � NG PAVING FENCE SIGN
WORK DESCRIPTION 4 ?&47 j �%/ M /- ' f O / %( %% ;Ye-
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.
Address
Square Ft. 0 ( t ff / /f Estimated Cost(value)
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
ature of •ntractor o
Notary as to Contracto or
My Commission Expires: NOTARYPU�LIC TATEOE IDP
COMMI ION NO. CCOIX
MY COMMISSION EXP. MAY 25,1
** * * * * * * * * * * * * * * * **
FEES: PERMIT 7 7%i U RADON C.C.F. .5-oil NOTARY TOTAL DUE 8' P'
APPROVED: Fire Other
Zoning :uilding ` fl ( Electrical
Mechanical Plumbing Engineering