PAINTSignature of owner and/or Condo President
PERMIT APPLICATION FOR MIAMI SHORES VILLAGI
2
Date - J du Job Address Z ° ( S Tax Folio
Legal Description Historically Designated: Yes
Phone
Owner/Lessee / Tenatir 0 . flG r Master Permit #
Owner's Address • C------ 7
- 1-0 S�
Contracting Co. a'��/L -� Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Square Ft. Estimated Cost (value) 5
ignature of Contractor or Owner- Builder Date
Notary as to • y r er and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires: My Commission Expires:
J a e c6/'e,-4 i. .
`0
3� / � f
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION J 17 0 J 11 kJ-- � I,GOX S j g(/4L-
FEES: PERMIT / RADON C.C.F. ' 6 0 NOTARY -3 BOND
APPROVED: TOTAL DUE
Zoning Building '-J ' ` 1 ' Electrical
Mechanical Plumbing Structural Engineer
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 a)movenamed contractor to do the work stated.
Date 4 / 22 / c3 Job Address ,./.9c) foe_ q s 5+
Legal Description
Owner / Lessee / Tenant P6 Fpe- C . (\A CL 11241Ck { SGr1Master Permit # 3
Owner's Address 4, )4•
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Tax Folio // 7)0
Grp / Z ,/,;L/ c; A f f c / ,I
Phone
Contracting Co. Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Pal y t" back- LA ot-r'cL
Square Ft. Estimated Cost(value) .3,5 0
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, PLUMBNG, 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.
Notary as to Owner and /or Condo President
My Commission Expires:
** *
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APPROVED: Fire
Zoning ( Buildin
Mechanical
Signature of owner and /or Condo President Signature of Contractor or Owner- Builder
Date: Date: !/�/�/9!
NIftleiNe
tary =s to Co
y Commission E
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*
FEES: PERMIT ,022 RADON C.C.F. pip NOTARY .5�fif%
Caeitn 6 cAy
l Dwnei ter+BIBi�d�@ 1
,\'44141.44): P ° .• • No. CC197545
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0 EPHINE CHURCH
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TOTAL DUE / !4
Other
Electrical
Plumbing Engineering