ELECTRICALDate - 9 — 94 Job Address 36 /1/Zr 9 ? '1 3T Tax Folio // D /SC z
Legal Description ,4-R5 /3 & / aii 5 0 1 £X N) P &70
Owner / Lessee / Tenant jelr Master Permit IP
Owner Address . > //.2 • %6 Y .
Contracting 0
Qualifier
Architect /Engineer
Bonding Company
`".or,.gagor \-
Permit Type(circle one): 3UILDING
WORK DESCRIPTION
** * *
FEES: PERMIT
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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ELECTRICAL
Square Ft. Estimated Cost(value) 3
: , - a T - T - F COH14.E FAILURE .,N�.t�.. . _ _ �.'_ . ..� _.. _. SIC_ _ .._ __ .,.. ...;1C...:1:..`i AND YOUR TO DO r
M =- '. U :. T ::•f : _ . _ A _ : NG 7W:OE FOR : NTS TO YOUR PROPERTY _' (I F YOU INTEND
.,S.A_N _ :NANC ::I :�: : YOUR :.ENDI -. OR AN ATTORNEY BEFORE RECORDING YOUR
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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: : cerzif that all the foregoing information is accurate and that all work will
Oe one in compliance •.i_ :h all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
gnat• re or owner and, or Condo ?resident
Date:
Notary as to Owner and /or condo ?resident
?y Commission
`?(t F P(je O NO1ARY SEAL
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Zoning
Mechanical
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Phone 'J( Cp clL—
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Address\
Address
Address
1'LU RING MECHANICAL ROOFING PAVING FENCE SIGN
/
Signature o
Date:
Fire Other
tractor or Owner - Builder
rotary as to Contractor or Owner - Builder
My Commis
`p ,RY P No!
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5ARINA M WINSGH
* * * COMMISSION AVtNJCrt
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Building Electrical 0 )
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Plumbing Engineering