1993 DRIVEWAYPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date / __ x Job Address/W4'2— WC 5 c
/ Tax Folio / / 0 03 /2 e‘',' ®
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Legal Description J r AM , Y 11 1i 25
Owner / Lessee / Tenant G' /7 t3 Imo= /Z j i Master Permit # 3 WY
Owner's Address /O 4 /2- -'V 9c s T Phone 75" 7 /776
Contracting Co. Z!5//WS Ce,/Z / Address A S W s S % 00. e
Qualifier 7'/9/! 5/1175 SS# Ye'Phone 52C'> S' ? 7 — 7
State 0 Municipal 0 Competency A 06) Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION /A/S 6' ,f .. /r1?t /z0Ch' /x17SF 6
/ J /c.4 /97/2 fr7S O6'
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Square Ft. S S� F/ Estimated Cost(value) ®0
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires: My Commission
Zoning
uildi._J ZL
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.
** * * * * * * * * * *
FEES: PERMIT. 3 7 /- RADON C.C.F. ,5 NOTARY , 4Oa TOTAL DUE /71
APPROVED: Fire Other
Electrical
Mechanical Plumbing Engineering
1.41■11.01110114•4.40s.y. .40
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2b6 ALHAMBRA CIRCLE - SUITE 404
CORAL GABLES , FLA. 33134 THOMAS J. KELLY, INC.
I (306) 7 3:s. LAND SURVEYOR
FAX : (3031 44I' -6464
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