PAINT PERMIT.�/,/ /, /TJ PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ,`)Gcft Job Address y7 'ilk 9' ( s � Tax Folio
1
Legal Description
Owner/Lessee / Tenant ) 0R,11/ / pati9 2
Owner's Address
Contracting Co. 1O En l , 00,1)9T'
Qualifier floT ( t
State # Municipal # /y6 D
5/5
Square Ft. a l ,a0
WARNING TO OWNER: YOU MUST RECORD
RESULT IN YOUR PAYING TWICE FOR IMPROV
CONSULT WITH YOUR LENDER OR AN ATTOF
Application is hereby made to obtain a permit to do '.
certify that all work will be performed to meet the star
permits are required for ELECTRICAL, PLUMBING, S
er and/or Condo President
Signature of o
My Co
Notary as to Owner and/or Co) • - 1 1
FEES: PERMIT 40 - RADON
APPROVED:
Zoning
Mechanical
O �S>�i7DY1 utesr CIAL NOTARY SEAL
SANDRA M MONTIEL
* COMMISSION NUMBER
CC401261
7 r (< , �� MY COMMISSION .EXP.
Or oP AI-M, 17 100r4
Building
67.E
Date
Date
(w
C.C.F.
-, ter
Historically Designated: Yes No
My
Master Permit # 3 8577
Phone 7J!' 1-- 3.5;5
Address /�, 1 'Nse ( 91- 17)
SS# - Phone 77
Competency # /Peg Ins. Co. J9R /E
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING
WORK DESCRIPTION f e„5 o -a P��/9� T 7✓Y /N� �X R�O'� K / 1 /1 7 - - 4;74 / C)
Estimated Cost (value)
COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
„ 'FRTY (IF YOU INTEND TO OBTAIN FINANCING,
YOUR NOTICE OF COMMENCEMENT.)
above, and on the attached addendum (if applicable). I
3truction in this jurisdiction. I understand that separate
IECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing r ...on rs n.,cm - a« aim 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
Electrical
S ignature of ontractor or Owner- :uilder
So
(7 SANDRA M M EL
�x� * COMMISSION NUMBER
Q CC40126
4O MY COMMISSION .EXP.
0, OF AUG. 17 1P26
Notary as to Contractor or Own
•
FENCE SIGN
C6 - ' 9 � , 157i�
Date
Date
O0
TOTAL DUE
Plumbing Engineering