PAVINGDate 31171g4 Job Addressa k).6.9ancl. S E.
Legal Description Y ) a4 L0< 1 C1cJ _
Owner / Lessee / Tenant2 �Tna�a rl0.gtt�
Owner's Address l aSCo r4 S ±. hr es Phone 75°Z- 83
Contracting Co. O(.0 Oe(2_—. CO .J TQ & c r " —
Qualifier f0 l SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICA ROOFING PAVING FENCE SIGN
WORK DESCRIPTION bl of C)1c\ i �'b��n10. �j(` 1 <Is t r -75:x - r cam. 6)-1 £c�
1 r� r C.-K . c c r-cl, l � Q�c.� rt ' `�� . loc�e.rr Gkyac,IL Gnc_e_ i, .
Square Ft. a ) 4 '1 Estimated Cost(value) o .—
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
aize the above -named contractor to do the work stated.
‘,2A414-, V0,101,m2cA-
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Signature o+ er and /or Condo President
Date: Marc
APPROVED:
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Notary as to Owner and /or9mcpAc �i�dt FLORIDA.
My Commission Expires: PAY C®1N?M_"JM1`1 EILIPEES: Dec. 29, MS.
** * * * * * * **
FEES: PERMIT '7/50 RADON C.C.F. , Q NOTARY 5 f° TOTAL DUE
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Fire
Buildin
Tax Folio fl f20 0 GOO 3
Master Permit # KR
Address SA-J't S
Signature of Owner- Builder
Date:
Notary as to Owner- Builder
My Commission Expires:
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Mechanical Plumbing Engineering
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