GARAGE DOORPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3 Jo Address 3 7 5 �V E q S Tax Folio / t'�o? Dl�, /5 (0a 4Z) 5
Legal Description LOT 30 / 4 7 / it /1' S• 3E&
Owner / Lessee / Tenant �i�e-"Z 3bA..) Master Permit # - i
Owirr 's Address 350 , q 2 07 Phone 75' -- Z7 /P
C Itracting Co. , ll)QP PR, OF PlOgJM Address 3 5Q) a) 494_
Qualifier 7;9 m LU II,MEG SS#,21, Phone .S'3 - S5 7
State #4.6C/b Municipal # Competency # B / Vad 7 Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 6 dO'9O!
Square Ft. Estimated Cost(value) C7 CV
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 don in compliance with = applicable laws regulating construction and zoning. Furthermore, I
aut ize the above nailed contra tor to do the work stated.
Signature of owner and /or Condo President
Date:
tary as to Owner< an• /Ipp1E3
My Commissio 4.6I9a' ":
** *
CO
Signature of Contractor or Owner- Builder
Date: 3 /3ibi`f
Notary as to C. lfb, N INKIIr
My Commission �� (' c) SCOTT W DAVIS
q COMMISSION NUMBER
Q CC255237
Ti ' "'�' q MY COMMISSION EXP.
* * * * * * * ; * OF PP. .1: *. _ 25/k1997 tt
FEES: PERMIT 1,5 v RADON C.C.F. i NOTARY ) 5'660 TOTAL DUE "I1
APPROVED: Fire
Zoning Building
Mechanical Plumbing Engineering
4 Other
Electrical