PAINTContracting Co. u
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WORK DESCRIPTION
Si
FEES: PERMIT
APPROVED:
1 1IT APPLICATION FOR MIAMI SHORES VILLAGE
s> '3F' 1 V e. gala S *Tax Folio
Date
Legal Description! Historically Designated: Yes No
-\.131-0 f
Owner/Lessee / Tenant !! but SLR/ 1 ` Master Permit #
Owner's Address I N. C ?C T: Phone 7 V E& \
S4 �10K
v , Address
Qualifier KI/T\ b2'k* 81A SS# Phone /
Competency # Ins. Co. t e./ 1/--7 e 4( g
Address
State # Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
otary as to Owner and/or Condo President
My CommisssiomExppireT
' (� F L V��9YQiaV Sr2aL
<- za^. ; .12Q C1 C O JYI eL
n
49 ;^v .E1P.
97.5900
Square Ft. Estimated Cost (value)
r 0,0
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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 re lating constru on and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
ature of own : and/or Condijl resident Date
Zoning Building 4
e,4
Date
1 4 0, RADON C.C.F. .S0 NOTARY
/0
Address
yip of Contracto or Owner- Builder Date
ce_4,eft_e<J
tary as to Contractor or Owner- Builder Date
My Commissi os:-- =__ - --
4;47\f,„7.,,,Y■rc , ,,',A , " ,),, - a Cl '
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. ,r ,776(6?,,A,,,,s3 1
• TOTAL DUE 6 14 -- S
Electrical
Mechanical Plumbing Engineering