PAINT PERMITDate ' /,
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address yr1) GJ/ / : - 7 Tax Folio
Legal Description Historically Designated: Yes No F!'
Owner/Lessee / Tenant 0 . . ' �_ �� ° Master Permit #
Owner's Address /re'/i
Contacting Co.
HP 11
41
/.k � ;-
Qualifier SS#
State # Municipal # Competency # Ins. Co.
Architect/. ngineer Adf;ress
Bonding Company Address
Mortgagor Address
Permit Type (circle ore ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESC
A if
Square Ft Estimated Cost (value) ry ,
WARNING TO OWNS " : U MUST RECOR t° A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO I O SO MAY
RESULT EN YOUR i'AYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH Y i1 UR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
41_
FEES: PEWIT t RADON
f
APPROVED:
Zoning Building
Mechanical Plumbing
Notary as to Owner and/or_ Condo resident Date
My Commission Expires: ;1`r p
g t. 0
•
Address
Phone - 4) - 7,
Phone
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.
Si . ature of owner and/or Condo President Date Signature of Contractor or Owner- Builder Date
C.C.F.
3
1400
Notary as to Contractor or Owner- Builder Date
My Commission Expires:
NOTARY
Electrical
TOTAL DUE
Engineering