FENCEPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date r 2# 4 Job Address 1(j (D O » 6 9 �({� . f Tax Folio
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Legal Description PL A t" .60 -0,IL - 4 Historically Designated: Yes No V
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Owner/Lessee / Tenant / /Yl R''-t 9 /...) n1 O j e _
Owner's Address i /o Lc O #JE
Contracting Co. ie- iv i'H --
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State # Municipal # Competency # 21080 Ins. Co. Am dQI c 4sJ asum,1 j 14+5 03.
Address
Qualifier
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVIN FENCE SIGN
WORK DESCRIPTION i I 1114►i BS Lit.) i f ..5' FI, &aa (-vee,j Vs tiyn l. WI g,
1A)YOUitit aV:kei des. (4 st
Square Ft. Estimated Cost (value) r 4 7 es 4 D°
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.
Signature of owner .ands ^do President- Date
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c' ��:� cc •i!
otary as to Owner and/or Condo President
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FEES: PERMIT 1 /0 • RADON
APPROVED:
ing Building
Address G 4 / N LJ / [ / jr
Date
C.C.F. r S � NOTARY
Master Permit #
Phone / 7 S ( 7-4 3
ature of Contractor Hf Owner - Builder
to Contractor or Owner - Builder - - f '
=mission y ` mission E • • - : JOEL BRODER
- - b My Comni "Exp. 2121( ,
2. Bonded By ��a *e Li
o. CC53471
ersonally Known ()011ie Oype C A.
Electrical
TOTAL DUE CO
ce
Date
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Plumbing Engineering
7444
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