ALARM PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date l ' 0 Job Address #95.04.. l .17 Tax Folio
Legal Description Historically Designated: Yes No
&a/Lessee / Tenant LOV FGsy .•L "kf eve.9P Master Permit # 19 8
•
Owner's Address zics /V, a ' 9/
Contracting Co.
Phone 75 7//
2 1�C Address7Az$'N. i. ( ?3 57
Qualifier f e # ' WJ 1$ Phone
State # gGeetpote,1 Municipal # Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION ROI, A ' i
"se•4-5 aocam./2O 5
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
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 . d zoning. Furthermore, authorize the above -named contractor to do the work stated.
and/or Condo President
ature of o -
it COT
ondo President
Date
(o
Ii /
otar as to • wner C or r
My Commission Expires:
OFFICIAL NOTARY SEAL
ALISON J ZOROVICH
COMMISSION NUMBER
CC596891
MY COMMISSION EXPIRE-
OCT 28,2000
FEES: PERMIT ` �Gz't90 2 RADON
ate
97
•
dr
3
Owner-B
, C NOT • • SE L Da e
JOYCE E 1UTTLEF FLORIDA PUBLIC STATE
ION NO- N 1997
MY COMMISSION EXP•
gnature of Contractor or
y Commission Expires:
tp
C.C.F. f NOTARY
APPROVED:
Zoning
Mechanical Plumbing
Building
as to Contractor or O
Electrical
Ins. Co.
er- Builder
?5 7'746
/
Date
ld
BOND
TOTAL DUE J-r— ( .
Engineering