PAINT/Legal Description
Owner/Lessee / Tenant
PERMIT APPLICATION FOR MIAMI SHORES VILI
Ate / Job Address ./a6 6 9 S 7 ' Tax Folio
Historically Designated: Yes
Master Permit #
Owner's Address
Contracting Co. 2p/ 7P 4 / At 7( /30 ¥ •
Qualifier 'II, c..�e A � (z ss# / DJ 9f /J S f
State # Mum ' # Competency # 0 /W- 4 / Ins. Co. �r In •4 o■y
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
otary as t
My Commission
FEES: PERMIT 3 V RADON
APPROVED:
Zoning
Mechanical
r erz —
him /PaPiks
/66o St
CA•
Building
lit>
a � f owner and/or C . • , President
"; , ;',f,C � do MbtlWASKEWY
• • ' = MY COMMISSION # CC 721000
:, off EXPIRES: April 10, 2002
•.q . Bonded Nu Notary :`.odic Underwriters
Date
C.C.F. t/
aL
Phone 3 o s' 75 /
Square Ft. Estimated Cost (value) / 7 e r
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.
Arilt Signa e of Con for or Owner -Buil
A./ '/ ..l
or = • ` J VILLAR
COMMISSION No C71 103
MY COMMISSION EXP. MAR.1
ate
otary as to Contracto
My Commission Expir
NOTARY
Electrical
BOND
TOTAL DUE I
'6 2, a
,P' 3
Date
Plumbing Structural Engineer
o,o0