FENCEPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Legal Description / / t 1 a M. I as-a, Sa 2 Historically Designated: Yes No
Owner/Lessee / Tenant SOS (/1 L61 LAOS 0 Master Permit # 3g
Owner's Address `17(/ N E 9S eL/ . Phone
Contracting Co. /u /A" Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company
Mortgagor Address
WORK DESCRIPTION
Square Ft.
FEES: PERMIT
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ign ture of owner an or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
RADON
C.C.F. ►�b
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOF 1 G PAVING FE CE SIGN
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' AFFIDAVIT: I cert ' ' at all the foregoing information is accurate and ' at all work will be ..Ile in compliance with all applicable
laws regu sting construction an o g. Furthermore, I authorize the above -named c/ tractor to do the w.rk stated.
Estimated Cost (value) 6 O 0 G o
Sign ture of Contractor or Owner- Builder
Notary as to Contractor or Owner - Builder
My Commission Expires__ = __
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NOTARY
TOTAL DUE
Date
Date
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APPROVED: J 9T51 Electrical
Buildin 9;t7)
Zoning Building
Mechanical Plumbing Engineering
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