ELECTRICAL PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Z. Job Address /C Z'S M 1 Z s7 ` Tax Folio f/_ 32 Q/ .ro
Legal Description P �h - �� ' �� � Las 9��U �� g Fr Z
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Owner / Lessee / Tenant Cam'? LLZ S so; z Master Permit t' : 7S
Owner's Address /60...c N C 72. s lda / S''ss Phone 7/7- 3 i-C'
Contracting Co .=^17Yu a - K JeM -47-1 414 ST Address 1933 N& /43-0'7 A/M'j 33%6Z.
Qualifier \/�«dy S - SS# Phone 9 v9 -emu'
State #6.F o'4'79 Municipal # Competency #i('a Ins.Go.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION '3 f /Ae /g 1��re"? -j- A/S7 Gt--7 T7 °"I
/ cdicltra/ /? ..ev. �s
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 thEl all work will
be done in compliance with all applicable r egulating construction and zoning. / Furthermore, I
authpize the aboy -na d contractor to do th- •r - ted. /■ 1
Si
Date:
Notary TePOwnff
wn
My Commission Expires:
** * * *
FEES: PERMIT 1 / 1,4
APPROVED:
4r,f./14 . ' .l 3/7 /-
re of owner and /or Co do Presid t
„
, JufliErzaw
N 1 CC253637
Zoning Building
Mechanical Plumbing
Signature
Date:
Notary
My Commi
Fire Other
1,q
C.C.F. ! D 0 NOTARY TOTAL DUE5o 'c2
Electrical
Owner- Builder
**
Engineering