PAINT1/ DateJ� ( /Q3 Job Address� 7 )g 9y
Legal Description 7'7 a O
/owner / Lessee / Tenant /
/ Address 4 /C2 - / V /
Contracting Co. 40
Qualifier SS# - -
State # Municipal # Competency #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
l/ WORK DESCRIPTION //
� cP�cc� �' i eta e�T /JS
Aut
4r All-
Square Ft. Estimated Cost(value) 75
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- med contractor to do the work stated.
Signatur of owner and /or Condo President Signature of Contractor or Owner- Builder
Date : 2r� /0
/1/1271. P Oe ,' • .
ciAlotBrttatiodStigoillonde
e aatyCommissmnExp.ijuIo,19s
o►r �op` O No. CC197545
Noty a to Owner an
My ommission Expires
** *
APPROVED:
Zonin
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
in
Master Permit # .0
Address
Date:
Tax Folio /)20Z v2 ® 00g 7
Phone
Ins.Co.
Phone X30,- - '7,5/ -
Notary as to Contractor or Owner— Builder
My Commission Expires:
FEES: PERMIT g lib - 61 RADON C . C . F . -D NOTARY ` D 0 TOTAL DUE 1 11‘
Other
Electrical
Mechanical Plumbing Engineering
PERMIT APPLICATION FOR MIAMI SHOR] r
-' A GE
Date 1 \ (1" 01 5 Job Address L) F qk) Z Tax Folio 4
Legal Description Historically Designated: Yes
0./Lessee/Tenant ' H a i n ca ( J l 1 ve 10 I .o ble ra
Square Ft. Estimated Cost (value)
Signature of owner and/or Condo President Date
Master Permit #
1)41clo,
•
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date
My Commission Expires: My Commission Expires:
No
Owner's Address qa OE q Phone
e. 51 3& 3 PR LI-6111
Contracting Co. 0 i ) (( Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION PCB I n — ca I PP.P r:2 ICU fn I nq
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.
du ,4 5,e j� -q -q
Signatur of ContractorOwner- Builder Date
- ay). c?». //-9-pr
FEES: PERMIT 4_10 RADON C.C.F. . NOTARY S• TOTAL DUE
APPROVED:
Zoning Building r Electrical
Mechanical Plumbing Engineering