DRIVEWAYLegal
a
Description
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address / xi& / / -sr Tax Folio
Zo/ /5 1 ge/c- 5
Lessee / Tenant ! Z i it.J C C1' Master Permit # 3.0/3
/e 9o /0_- 9 � �J Phone 75Y— c70 3/r
Contracting Co. /4' fQ , 9 0 / ,c✓ Address / /% 7 5:5 -- • ,' //OA!
Qualifier
/2 6dA.,07A ������
Phone `�
State # Municipal # Competency #1 : !3 /S4( Ins.Co.
Architect /Engineer Address /
Bonding Company 4- Address
Mortgagor Address
Permit Type (circle one): BUILD G ELECTRICAL PLUMBING MECHANICAL ROOFIN FENCE SIGN
WORK DESCRIPTION .CerJC4.5 f' CI;� �. / 62.4 ��/ ;
t / ( Cr 7 )
Square Ft. /729e
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, ROOPING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in co iance with all applicable laws regulating construction and oning. Furthermore, I
authorize t e above -naj -d contractor to do the work stated.
Ain ■fi
i
■ itot/ .
o . " .4 1 1117 er �n•V Co
Signature
Date:
Notary
My Co + ission Exp
** *
APPROVED:
Zoning
resident
MIRIAN M. VIDAL
MY COMMISSION 9 CC 393510
EXPIRES: October 19, 1998
Bonded TI411 Notary re Undenvtlers
to Owner dlor Condo President
Estimated Cost(value)
Signature
Date:
tractor o
Owner- Builder
Notary as to ontr
or pwu Builder
My Commission Ex pi NGf ID LOP
p " y Public, State of Florida
My Comm. expires Feb 22,1999
No.CC440959
* * * * * * * * **
FEES: PERMIT RADON C.C.F. lV NOTARY
Fire Other
Buildin � O Electrical
Mechanical Plumbing, Engineering
TOTAL DUE 14111,t°
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Permit No.
Name
Address
Company
Phone #
For Inspector:
Approvec
Correctio
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Req
75ZP 1 9& i Ce /
0 Name & Date