ALARMDate 1 c /Job Address /Z /N/ P ' Z So" Tax Folio
Legal Description
Master Permit # 570/3
E er Lessee / Tenant ^IR, jr ^y 4 6 a:9v✓ ry//
Owner's Address / 2. N e IL ev i sr
Contracting Co. C 6 S 7.; ("Gil /4) -.
SS# , Phone 3�� - 7 ? /-- 9'r a
State # / F '- °' Municipal # Competency # Ins.Co. }ec -0 ^
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
S f /J P.) s 4 ' i )
Qualifier /(C.
Signature
Date:
**
FEES
Notary as
My
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
<q n.✓
WORK DESCRIPTION ‚9(-4'- , } �w-
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 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 abo - -named contractor to do the work stated.
r and /or Condo President
C,72 ( Y 2 202 - i - c - 2 - 46 - 2
to Owner and /or Condo President
•
P(/ OFFICIAL NOTARY SEAL
e/ SANDRA M MONTIEL
)„, CCMMISSIom NUMBER
CC401261
(p MY COMMISSION , EXP.
APPROVED:
1 y LR�
* *
Zoning
Mechanical
Fire
Plumbing
Phone
N• ",,».4c', /mac
Address /8' °0 33 ‘c G
/ d‘.
Signature of Contractor or Owner- Builder
Date: /c)/t y/9 y
otar
My Co r kp,131.84, E7rptizreSI OTARY REAL. E
0 !. SANDRA M MONTIEL
* * COMMISSION NUMBER
ca 4 r%, Q CC4.Al261
* * * ', o ca AY COM SSION •E P. *
of F0 AUG. 171.9
C.C.F. /o` NOTARY 6. r TOTAL DUE
s to ContractororAwner- Builder
Building Electrical
Other i
11 OftWr
Engineering_
**