PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE "`'`
Date V2. Job Address 3'5 S 9 t Tax Folio 1 1 3Z oce O 1 (c
Legal Description Historically Designated: Yes No t/
Cck ,ob e
/ Tenant - � c k e t Master Permit #
Owner's Address c 1 .
Contracting Co. 40/1/4(6"
Mortgagor
Notary as to Owner and/or Condo President Date
My Commission Expires:
L IO
FEES: PERMIT - RADON
C.C.F.
Address
Phone `' 51 - 4 S O'r
1
Qualifier Phone
State # Municipal ° # Ins. Co.
Architect/Engineer
Bonding Company
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION Ra. t Irl " (7.3 -A S (ok e C> •1 rn - 2
Colo .moo
21c, - lvc<< ,n Park 04- �avS� CAt !'e I - OS 1 .v
Ca101/4r ,SGv.ok,s Ne, e c- 6o.c.
Square Ft. Estimatst (value) gOd
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.
Signature of owne President Date Signature of Contra�Owner- Builde Date
Notary as to Contractor or Owner- Builder Date
My Commisq,�,xpilgs: /ZZ / rJ -
oRy P(j MARGARITA MONTIEL
„ n COMMISSION NUMBER
CC797277
. MY COMMISSION EXPIRES
QF DEC. 17,2002
NOTARY
BOND
TOTAL DUE �ei
APPROVED:
�r �• ty
Zoning Building j / J l 47 Electrical
Mechanical Plumbing Engineering