PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date ( Of l�� ; Job Address
Legal Description „/,l9 ,V i/ 7 9
/ / Lessee / Tenant /„ <LA ru frr- 1 ( a eJ
E. 4
er's Address S JT /U 9/5/
Contracting Co. dalKM2W!
Qualifier SS# - -
State # Municipal # Competency #
- ORK DESCRIPTION p)4,,,
Tax Folio // .1(;W /7 4//V-5
Master Permit 4t, ii(5,9A
Phone ` 7 ! /- / 9/
Address
Phone
Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Pt. Estimated Cost(valuej
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 stat
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * * *
APPROVED:
Si_nature of Owner- Builder
ate :ln /'/9j
tary as to C
y Commission
FEES: PERMIT■g; RADON C.C.F. NOTARY .7 TOTAL DUE 0 12°
°
Fire
Zoning uildin:�� � � Electrical
Mechanical Plumbing Engineering
—
**
Other
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address ,� / / t S /, ., 9 I'ax Folio
Legal Description _ 1 Historically Designated: Yes
Owner/Lessee / Tenant K (C7A404-,
Owner's Address f - / 4 Phon 7-s
Contracting Co.) ' W Address
Qualifier SS#
State # Municipal # Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION AA.
i
Square Ft. Estimated Cost (value) 6a
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 ' k stated.
Signature of owner and/or Condo President Date
FEES: PERMIT RADON
APPROVED:
Zoning
Mechanical
Building
«rI
Notary as to Owner and/or Condo President Date Notary as o Con
My Commission Expires: My Commission
C.C.F. NOTARY
Electrical
//// No
T
Master Permit # c3 Z g
BOND
Phone
Ins. Co.
-
e of Contractor o er- Blder ui Date
!
] °Z oo 0
I /
Date
■tr
ctor or O1Il1ydMLL?\R
ARY PUBLIC STATE OF FL.OalDA
COM vlEION NO. CC7M103
Ii/.Y COMMISSION EXP. MP•t t,?O?
TOTAL DUE
Plumbing Structural Engineer