PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE n
Date Job Address / '3 .S/ Tax Folio / ( 32 C (o 0 / 'T / 7 '
Legal Description ° / V- / u'"t 1 /, e;3Historically Designated: Yes No
Master Permit # 3 ,:
eggiVE 93„77)
Owner/Lessee / Tenant 6-LO IL! 4 4.90 O
wq— exi
0 7. „ (26 )- A / (/ Address r , - /�t �Vt2 v` %� ✓� 74J
s � � // �/ P f i -760.5
State # Municipal # i - Competency #A0+1 Ins. Co. , az/
Owner's Address
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 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 contra tor to do the work stated.
/ 66-ykize. PrA-04 6
Signature of owner and/or Condo President Date
Notary as to Owner and/or C do President
My Commission Expires:
ZR -e_c I R - Tietw,oit 1). AA/ t S
OFFIC L NOTARY SEAL
SHELIA TAYLOR DAVIS
NOTARY PUBLIC STATE OF FLORID
COMMISSION NO. CC469304
MY COMMISSION EXP. UNE 5,1999
FEES: PERMIT /1 . RADON
APPROVED:
Zoning
Mechanical
OAP. s - 2i( -
Building
Date
C.C.F. l
Signatu t
r
NOTARY
Phone
actor or Owner - Builder
Not o Contra tor or Owner - But
M' Commission Ex ires:
U� / zb�r� .( 0/(-
OFHCIAti 6TAP.Y SEAL LF
JO C THOMPSON
r!OTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC:39CCG2
MY COMMISSION EXP. AUG. 10,1593
Electrical
TOTAL DUE
Date
Date
Plumbing Engineering