PAINTDate Id-c3 Job Address t4 3lp N q :=3rd t. m-5 1 a0Tax Folio // 3=7 / 0,2,/e29
Legal Description . '7 3 ' � % -s• Se(2, Z
Owner / Lessee / Tenant Ele. r\Ct 3 • 13ct Master Permit # )5'35
Owner's Address e- . M e°ri 2. S\ • I,\IcHv 331 3? Phone1 4 - (43t4
Contracting Co. F1r4o i 0 GZI,t i (D Address UO3 .c 5(p
Qualifier SS# - - Phoneo -Q1
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company ��jj Address
Mortgagor / 9 L/ Ce R/ vL= A, ItZrers Address /y �- • 4)1 ✓e. n1 O (9gJR cP.S
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION a. '.l { eC ..0 r r t'■ (>c1
Square Ft. Estimated Cost(value)4c /00 .0
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 complianc- 'th all applicable laws regulating construction and zoning. Furthermore, I
author the above amid contractor to do the work stated.
iii .11.4 /"_ °--
Signature of owner and / Condo President
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Notary as to Owner and or Condo President
My Commission Expire
APPROVED:
•
OFFICIA NOTARY SEAL
V ROSE SMITH
NOTARY PUBLIC STATE OF FLORIDA
** * * * * COMMI951ON Nt. COMM * * *
MY COMMISSION EXP. DEC. 11,1994
FEES: PERMIT J7SV RADON C .C.F._,/ NOTARY
Zoning Building_
Mechanical P
Signature of G� or Owner- Builder
Date: /a �� 72'
Notary as to Contractor or Owner- Builder
My Commission Expir
* *
OFFICIAL NOTARY SEAL
V ROSE SMITH
NOTARY PUBLIC STATE OF FLORIDA
* COMMISSION NQ. CC0708
MY COMMISSION EXP. DEC. 11 1494
Y TOTAL D '"
Other
Electrical
Engineering
Prir.t, type or stamp name of Notary Public
knowv. DOI: Produced I.D.
and number of I.D. produced:
Rkajp c?" _
DID take an oath, or
'ID NOT take an oath.