SHUTTERSa PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date '13 Job Address lo c /L. qs s — Tax Folio 1/ 3,3c; / / 3t� - - 5 C -' 1 1
Legal Description :.-Ot JO + r 3) m S hones ; C-- 1.7
Master Permit # 3 74 1/
Owner / Lessee / Tenant \...1'?_ e._
Owner's Address L) /l) `. ( 5 .✓3) ?`�
�� i �!RM I �S��C�� �; 1 Phone
Contracting Co. ' RCA +A) r. }• ,Sc' ,j S Shy CC Address 0 y N f L) 1.3 9 '/1i, ' '
Qualifier 3 'AJ , ,Pl`>�` - ( \ SS# ,/ ' - / Phone e?'/c r . v
State # Municipal # Competency # , < i '" Ins.Co.
, Architects ngineer ,.
Bonding Company Address
Mortgagor Address
Permit Type(circle one): UILDIN5` ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 7 i& (Y) S M CJ T1t 2 .&
Square Ft.
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
to do the work
authorize the above -named contractor
Signatu
Date: S
** *
cc
of owner and /or ton o President
as to Owner a
My Commission Expire
*
*
*
FEES: PERMIT 19, RADON
APPROVED:
Notary as to Contractor or. Owner-Builder
My Commission Expires:
t :5,711P;'d Ft; 1 1T, :::i : : i r '..2,;,, ° .:;.: s
ry CC'"�ESS ",t".i w' }; 1 :::S
* * * * * i�DED Tii *U Z:� Z4i_ IS.'S. * _ * *
TOTAL DUE 20 ." 1 15 1
Fire
Zoning Building
Estimated Cost(value)
stated.
C.C.F. ";4' NOTARY . -flo
Address b°4(
11 7 1
' ignatu / rga Aractor or Owner- Builder
Date to lI
V`4)
Other
41 2 1/3 /11 Electrical
Mechanical Plumbing Engineering