PAINT PERMIT/r__ PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date !� if 3 if b Job Address ° j ,G U P / �' - l 2 ' b'[ Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant > - 10 se tij - P Tf A Master Permit #
Owner's Address
/' 4/- 6 , 9 ' 2`
Contracting Co. /1e/5, /' h Ai/ (7 /c - 7 Address 3625 4 ,, /u,r. C L�o�ca�u,✓ Cab
Qualifier
State # Municipal #30 — 56 - 070/ Competency # K SOG32 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /° //' /rich
Square Ft. Estimated Cost (value /8.5 -
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.
of owner and/or • nd •
Owner
i• Ex
Signatur
Notary as
My Commi
APPROVED:
Zoning
Mechanical
d/o
Tres:
FEES: PERMIT
Condo
( 1-- C—q co
President Date
� 9 OF FI
OFFICIAL NOTARY SEAL
MONICA L BUCY
COMMISSION NO. CC301278
MY COMMISSION EXP. JULY 13,1997
' RADON
8
56
C.C.F.
Phone
Electrical
SS# Phone
8. - 263
7
ignature of Contractor or Owner- Builder
Date
i
r
Notary as to Contractor or Owner- Builder Date
My Commission Expires: —/ — rye
i: 4j P O0 f/PrcIAL Ne7GOV SEAL
0, 52 � Sian a Ca L O,JTIIeL
� ;7 S COLI..f!SSION F166[aD�tal
, r --6 _ NOTARY TOTAL DUE
Plumbing Engineering