PAINT PERMITPERMIT APPLICATION FOR MIAMI S
Date 9h//00 Job Address, 5/ 7 /U• E. (7/5/� N Tax Folio
Legal Description Historically Designates LL
Owner/Lessee / Tenant/ - DA N oy l2 E t k iS N/ /-� t2 ON
Owner's Address ') j/ 1 / 51'
Master Permit #
(.;
Phone 30 5 756-588 4/79 6385
Contracting Coy e "f� Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTIO E1` 1 t✓L t O, A (&)1
., \'''`e4h ` eC 1 /14:11A It 7
Square Ft. Estimated Cost (value)k 3Z0 s
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.
Signature of owner and/or Condo President
Date Signa . ontract for Owner- Builder
'
Notary as to Owner and/or Condo President Date N9Y as to Con
My Commission Expires: My Commission
9 //Z /O
Date
i'fforor6NREntailMfr ff ; Date
ires: GLADYS J V1LL411
NOTARY IUBLLC SI'AT, OF FLORIDA
COMMISSION NO. CC7 / 3
MY COMMpsipN EXP. MAR.
FEES: PERMIT � RADON C.C.F. ' NOTARY 3 / BOND
APPROVED: TOTAL DUE
Zoning Building ! 1 /J 'C Electrical
Mechanical Plumbing Structural Engineer
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