PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLA
V%0 Date Job Address [ / /V / 6 • 9-35 Tax Folio
TWT SW20Z3
Legal Description Historically Designated: Yes �- -
Owner/Lessee / Tenant NL / C1 f 7 Master Permit # 6/66
Owners Address Phone( (5 t� � �v
Contracting Co. ?).Q �D�, 4o� �`
Qualifier J D S-2 / Y d liJ .e 7i
Address 5 � J J b pI"
SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor
Permit Type (circle one) BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
•
WORK DESCRIPTION r / 7Jdl
Address
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 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 laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
I
/5ignp#!J#e of wrier and/of Condo ' t date / Sig �,; Contractor or Owner - Builder NS�a yzs' ‘i9 49 - o 4 . to e 45 —
/D -O0 ,I 4) vOlea
Notarf as to Owner and/or Condo President Date Notary o Contractor or Owner - Builder Date
My Commission Expires: My ' •mmission Expire : OFFICIAL 01 gy A
GLADY5 J VILLA!
NOTARY EU3LIC STATE OF FLORIDA
COMMFSSION NO. CC714103
MY CO W ESION EXP. MAR. i)2 1
FEES: PERMIT.,) D RADON C.C.F. 4 7- NOTARY ,) BOND
APPROVED: TOTAL DUE
S /J
Zoning Building 4 kliit'bc Electrical
Mechanical Plumbing Structural Engineer