PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAG
Date q' ()Y Job Address 2- / /v' g S Tax Folio /7 ....Z.0,6 / �,&
Legal Description 2'7 7 2 a - ce ii-/, -/ CZ /4ite
Owner / Lessee / Tenant NAtJoi L.S8 Master Permit # 3 .35
Owner's Address 9'IC NE ?/ S /27 )2 i SyIJnS' /4i, Phone � � v ' 93
Contracting Co. Ow kJ ER 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 G`-- =/, it) 0 U' t) /p L') /7 WC - ttii9/TL" - (/1 �'li^-'
Square Ft. Estimated Cost(value)
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. i
Notary as to Owner and /or Condo President
My Commission Expires:
Signature of owner and /or Condo President Signature o Contractor r Owner-Builder Date: Date:
Notary as to Contractor or Own Builder
My, - Commission __Expir_es_:._
!OTARY PUBLIC STATE OF FLORIDA
** * * * * * * * * * MY * COMP1ISSi0N OKP.
BONDED THRU GENERAL INS. UND.
FEES: PERMIT -V-5 RADON C.C.F. -' NOTARY TOTAL DUE' '
APPROVED: Fire
Zoning Buildin f Electrical
Mechanical Plumbing Engineering
* * **
Other