PAINT PERMITDate L 4. Z Address
Owner's Address k) oG Ct 2, Sse r
Notary as to Owner and/or Condo President Date
My Commission Expires:
APPROVED:
kPPLICATION FOR MIAMI SHORES VILLAGE
461 ci\, S7Tax Folio
Legal Description S ' F Historically Designated: Yes No P (
Owner/Lessee / Tenant KU • tA(, W)%iLe.(1 Master Permit #
Phone
Contracting Co. N i•V■ CibLV <f 11.�C, �G� �(J Address
Qualifier 3c/s40, G F1(J3 Mr— SS# 246 - - Phone
State # C (G S 7 ' Municipal # Competency # Ins. Co.
Architect/Engineer C1 Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one). BUILDING : LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION PA 1G64 l\SC Act. A . E VIAv (L Ate- —
Square Ft. Estimated Cost (value) 4 5, OJ
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be dAte in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do e work statM.
Signature of owner and/or Condo President Date Signs Contractor or Owner - Builder
2 - -
Date
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
FEES: PERMIT RADON C.C.F. NOTARY ‘,/ BOND
-0 I nay
Zoning Building / f C�/y Electrical
Mechanical Plumbing Structural Engineer