PAINT( PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / °/ f Job Address 3,2, /(/e s Tax Folio i/ o (o -. /2 - 6 yr n - 2
Legal Description `� / 7 L g y S / / V C /Historically Designs ed "Yes No 7
Master Permit # //b b Y‘iO
/`1 L)) ? 4 L
Owner/Lessee / Tenant
Owner's Address
Contracting Co. C) vti ( R,& — �A2 � � Address
Qualifier Phone
State # Municipal # Ins. Co.
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING. ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ,
0 +J2 .4g vnl o ( CSI /1 (N .r(oror' CS 1,, ,f') ,1(/
Square Ft. Estimated Cost (value) 4 / '1 3 . v15
SS#
Competency #
Address
Phone '7' 7 2 C. 4 - /
0 7,„ 1 17:4,e4-'
1 i7 2--(71"-T
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
1 aws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo President Date
— P
Notary as to Owner and/or Condo President Date Notary as to Contractor or
My Commission Expires: My Commission Expires:
'' /'i
FEES: PERMIT 41 a RADON
APPROVED:
Zoning
Mechanical
Building
C.C.F. J• NOTARY
Signature of C
tractor or Owner- Builder
Electrical
C11:%L
;"
BOND
TOTAL DUE
7/2 Vp 4
Date
Date
Plumbing Engineering
ILDING
,ECTRICAL
LUMBING
Owner of
Building
Work to be performed under this Permit
r ,
Architect
Contractor
or Builder e fs -"fit ill-
Legal Lot
Description
A ddress of
uilding r
Bl.
CONTRACTOR OR BIDER
PERMIT N° 10878
Subdi-
vision
Value of
Project $
Amt. of
Permit
I a OR BY 0 ;1F44.!3
BY AUTHORITY
MIAMI SHORES VILLAGE, FLORIDA
DATE ,•;;� ...
Contractor's
License No
/7)
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application
erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
awings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
- ne if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is
anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
-raining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
ne by his agents, servants or employees. A
Signed:
In consideration of the issuance to me of this permit I agr et r perform the work covered hereunder in compliance with all ordinances and regulations
Lining thereto and in strict conformity with the p ans, drawi s atements or specifications submitted to the proper authorities of Miami Shores Village.
ccepting permit J as um r pon 'bility fo ` ork do •y either, myself, my agent, servant or employee.
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