DRIVEWAY PERMITT
Date 3
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant LCI) (S T CPI-PC IZ f SO Master Permit # 9 L b L/
Owner's Address 9 2 /v2____ STr
Contracting Co. -
Qualifier 0 V
State # Municipal # 4 18ad
Architect/Engineer
Bonding Company
Mortgagor — Address
Square Ft. 9e
er
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 1 JE, 9 Is* ST Tax Folio
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
•
WORK DESCRIPTION
AP/"
ondo President Date
Notary as to Owner d/or Condo President
My Commission apices:
FEES: PERMIT ® RADON
Date
APPROVED: Buildin 4 Zoning g lf'? g
Address
SS# - Phone ab,5 esz.O- 5 7
Competency # t -Sae a Ins. Co. 922 °Area PeeRit
Address
Address
Estimated Cost (value) 46
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.
C A'
Signature of o
of Contractor • r S wn r- Builder
Date
Notary as to Contractor or Owner -B � �
My Commis .'.p �i liou'�
GLADYSI
NOTARY RIE 1C STATE Or aIA
�t9Ic1 NO. C am' i}111'. W Y COMMISSION 53 _
C.C.F. f • v NOTARY
Phone 3 5 - ?y, - C)
Electrical
a/ 49
Da e
BOND 300
TOTAL DUES
Mechanical Plumbing Engineering
is -O2 10'342n From- SLIASEU TIT:. IOC.
KETCH OF $CUNDARY SURVE\
• MALE -. • .
35
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IF ANY ARE AEr'2RRED 1O AN ASSUMED VALUE CF FOR THE
3EARINGS HEREON ( SALO BEARtNO 6 m91T1CAL mix THE PLAT OF RECORO
ACC0RDING TO THE N.F LP. THE SUBJECT PROPERTY FALLS WITN!N FLCOO ZONE:
SOS-1 SO /EO'd 881 -! 019°.EOSSOE d!1Y?a YOIa01; 1YUN3OOad-co 8 09 80 8!- E0-d'S
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