PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ) 3 I � ob Address C ( " L 9n1 1 Tax Folio — CD/60
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant 6a n C
Owner's Address ' 0 1 ' Z J " Phone
Contracting Co.
Q u a li fi e r 6 T T ,' 0 , " c 14-
Address
Master Permit #
No
ss# - -_ [Phone 7s ? CC,/
State # Municipal # Competency # Ins. Co. .S)`r-°Z `( 3 /T-L°41
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. - 3 ee;
r
k ' /re { �� • !� 1
C X r lc Os)
Estimated Cost (value) l C e
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.
Notary as to Owner and/or Condo President I \ate
My Commission Expires:
FEES: PERMIT
RADON
APPROVED:
Zoning Building
Mechanical
61 f _
Signature of Contractor or Owner- Builder Date
• COMMISSION NUMBER
y � . a CC542908
F O ' MY COMMIS,SICM EXP¢RES
OF F' _ _ APR. .1 ?,200n
C.C.F.
Notary as to Contractor or Owner- Builder
My Commi ssion Expires:
. PG OFFICIAL NOTARY SEAL
2 �� SAMUEL F MCCOY
NOTARY
Electrical
BOND
TOTAL DUE
Date
Plumbing Engineering