1997 PAINT 79 NE 91 STSquare Ft.
Notary as to Owne and/or •
My Commission Expires:
FEES: PERMIT
PERMIT APPLICATION FO R 1V,IAMI SHORES VILLAGE
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Date iVirk -9 Job Add /
Legal Description a V(/'� /� - Q J � t 7'F. G �N Historically Designated: Yes No
Owner/Lessee / Tenant DuoKrE 2 - 6u )a /'&2/ Master Permit #
O w l e t ' s Address ' l q Ni' E q t gh0QES Phone f l;) l / 6 53I-q33/
Contracting Co. NIOl J& — DI Y ER
Qualifier JJvr Di(,.(!t3/&'.
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ignature of owner and/or \p
RADON
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Date
Folio 1 5PD L)3 0/
Address
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Phone "750-53'70
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company °” Address h tI E
Mortgagor Address
ti a WORK DESCRIPTION
Permit Type (circle one): BUILDING ELECTRICAL PL/ O l� s U BING MECHANICAL RI
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Estimated Cost (value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND Y t . i ' ' 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 re ating cQnstry6lion and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Contractor or Owner- Builder
Notary as to Contractor or Owner - Builder
My Commission Expires:
C.C.F. f 60 NOTARY BOND
TOTAL DUE
ICE SIGN
Date
Date
1 ) 1 Electrical
APPROVED:
Zoning Building
Mechanica: Plumbing Engineering