PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7 i 7.01 Job Address y 1 07 U 93 Tax Folio // -32 6 I/3 —3 000
Description _ Historically Designated: Yes
Master Permit # 7 ` ,
Owner's Address 101 V2. 9 3 • coi Stut{-, S/ 3ephone)4 ( ) ZS 1
�
Contracting Co. 0J\
Qualifier
State #
Architect/Engineer
Bonding Co
Mortgagor Oat( ad/IAL
Permit Type (circle one):
WORK DESCRIPTION �� �✓ W
Square Ft. 2- fa)
W
PAYING
OR ANA
Application
will be per' PLUMB
OWNER'S
constructio
APPROVED:
Zoning
Mechanical
No
/Leswe / Tenant> ' e/1/10.4.- 4. Octi
SS# Phone
Municipal # Competency # Ins. Co.
Address
FEES: PERMIT
oo / RADON
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
Building
ELECTRI
f rovl
AL PLUMBING MECHANICAL ROOFING PAVING FENCE
-
Address f ''
Address 0A � Z 4ve- 116616144
No
Address
SIGN
Estimated Cost (value)
NCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
U INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
MENCEMENT.)
ted above, and on the attached addendum (if applicable). I certify that all work
urisdiction. I understand that separate permits are required for ELECTRICAL
nd that all
o do the
My Co
r �
(JO NOTARY S
will be done in compliance with all applicable laws regulating
tated.
Builder
w°' �— gib - 43 - 'V s - 5
ssion xitago tS J VILLAR
NOTARY PUBLIC OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2(102
Electrical
BOND c O
TOTAL DUE
a 5 1 4 5 i 1
�0 0
ate
Plumbing Structural Engineer