1993 PAINTPERMIT APPLICATION FOR MIAIVI SHORES VILLAGE
Date / Job Address ,i 7e gYAet Tax Folio // i I /1 050t
Legal DescriptionK2 p.i' / /.4J a i 7 721 , ) 1 /
Owner / Lessee / Tenant )tag - '5 -,7 Master Permit #. 77.
Owner's Address gp 'y -/ 1e 9,9714
( Phone 74L9
Contracting Co.
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
‘;1; DESCRIPTION ti €
Address
Square Ft. Estimated Cost(value) 0C
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 state
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
APPROVED: Fire
Zoning Buildin
Mechanical
Signattu�e / � 7 oof�Contractor or • rr- Builder
Date:
Nk ar as to Contractor or Owner-Builder
My Commission Expires:
** * * �� * * * * * * * * * * * * .� **
FEES: PERMITig2 i, RADON C.C.F. �� NOTARY 5 TOTAL DUE grO
Other
Electrical
Plumbing Engineering