ALARMDate \2 Job Address
Legal Description
WORK DESCRIPTION
Sig
Date:
Notary a
My Commi
- -
. - :_AEPROYED
•
'' .= ....
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Owner/ Lessee / Tenant r
Owner's Address � v uvE q 6
C& L Y1 U MCktd�
Contracting Co. � � dress
Qualifier Gn '` \ SS,k (/ Phone
State iPCV p735 Municipal fet
Architect /Engineer
Bonding Company
Mortgagor
Permit Type(circle one): 3UILDING
`PERMIT -RADON
Zoning -' ==
rtnrt,2n; rat
Folio I 3266O1 33110
frts w
Square Ft.
n &o President
Age
qiv er Boot&
♦r resi� SypN NUMBER
z� 9e, ► ;x679543
u Q 9rn*Sa EXPIRES
* � a F a'� , .1 2001
Master Permit It ( --/ o2 c 9
Phone (90S)15 ` 33
7 75VO
Competency p Lns.Co.
Address
Address
Address
LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE S
resident
ax.
Estimated Cost(value)
Signature
Date:
Notary as
My Commiss
bob a 0
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
30 MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INT:
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y(
NOTICE OF COMMENCEMENT) .
Application is hereby made to obtain a permit to do work and installation as indicated above,
on the attached addendum (if applicable). I certify that all work will be performed to meet
standards of all laws regulating construction in this jurisdiction. I 'understand that sepal
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFI ►AVIT: I certify that all the foregoing information is accurate and that all work l
be done in ompliance with all applicable laws regulating construction and zoning. Purthermor(
authorize he above awed ' ontractor to do the work stated.
of Contractor or Owner - Builder
0 61:
► 1de,
' H UBERT0 rc6N
s. NUNER
� * C 01,1.YSSION NUMBER
• \ a CC679543
MY C �)INlIp EXPIRE
F C °k EPT 2001
C.C.F. + U' 0 NOTARY TOTAL DUE `7
Fire Other
Building Electrical - a 4
Plumbing Engineering