FENCEDate z Ct Job Address\ 9: 4125.7.-
Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant - c1", \ ) te-
Owner's Address Phone (7 — ' 7S 1 � � `'
Contracting Co. (3'k / /` F ( _ Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION rn Tck 1 I r s.5 \/q nod Fe X t t rl�
k 11 r\ NC ±- b e e w, p tl-e C - to co r r ec -" tJ i l c f 1 a
Square Ft. Estimated Cost (value) 0
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. Iunderstand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all ork will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the ork stated.
Signature of owner and/or Condo President Date Si a of Contractor or Owner - Builder
Notary as to Owner and/or Condo President Date Notary as to Con
My Commission Expires: My Commiss
ci, - 1000-' FD
KuAr
141, '
FEES: PERMIT �® RADON
APPROVED: `°
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Building
C.C.F.
to
NOTARY
Electrical
Master Permit #
tor or Owner - Builder
BOND
4 et 7
Date
OFFICIAL NOTARY SEAL
c r . .
NU
T 11402 [ 7
COMM!M IIBE
Aral -797277
S 8310N EXPIRES
L Q ... DE G. 17, 2002
TOTAL DUE
Date
Plumbing Structural Engineer
SKETCH OF SURVEY
SCALE: i" =