PaintDate - Job Add
Legal Description
Lessee / Tenant
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
r's Address
Contracting Co. DGV✓
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
WORK DESCRIPTION �-
Square Ft. Estimated Cost(value)
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMP:!OVEMENTS 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, ROOPING 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 cons uction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated. Li A.aii, / // /, o
•/ / :� 2 4 r l 1!' Builder
40
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * *
FEES: PERMIT 1 6' RADON C.C.F.
APPROVED: Fire
Zoning Buildin
Si
Da
Notary as to (P'ic`� �0 tF1 W er
My Commissic � e l3 ' : COMMISSION NUMBER
�i_ CC255237
� e MY COMMISSION EXP.
* * * 0 F‘LC) . JAN _ ____
Address
Tax Folio 3d 6( /� �.3
t
Master Permit # L1
Phone
. .y_ ,
4
6*c_try
*
NOTARY 5, TOTAL DUE 1 11 4
Other
Electrical
Mechanical Plumbing Engineering
•
04
l eL f L N -
1;e134 i S ko k i 'Y
•
9
111 n CAer
t ✓en+ d6G
Ceic r
*.L
fiv r
.A•N f > C.a 1 S ����� 1•1 i leo-4S-
WORK DESCRIPTION
Square Ft. �� 3 1
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / - y 7 Job Address 3 (r0 (0 ArE 93 ' t Tax Folio
Legal Description lei- :historically Designated: Yes No
Owner/Lessee / Tenant A f e r 07 ti C ei- &J t4 -t a 6? 41 Master Permit # 4 /0 8 2-3
Owner's Address S (( (7 M X1$ S % V-e2( Phone 1 J if - ViL'
Contracting Co. t ,, Ct /c/ ( Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILD I ELECTRICAL PLUMBING MECHANICAL RO FING PAVING FENCE SIGN
Ekt et-iv, 'PU,i U f ( r at C (yet 1'(.JU � 1,11f1
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 BEFO:IE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and instal ation as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all lows regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOL, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: ertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construct .n,Lind ing. Furthermore, I authorize the rbove -named contractor to do the work stated.
Signature of owner and/or Condo President
Notary as to Owner and/or Condo President
My CommissionExpires:
FEES: PERMIT L ila RADON
Building
-� f - ?
Date , Signature of Contractor or Owner - Builder Date
Date
Estimated Cost (value) t' U J
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
C.C.F._ f • NOTARY • BOND
TOTAL DUE •-(6 t
Electrical
Plumbing Engineering