PAINTn PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date = 30 %6 Job Address 5 V /Z/ ,S. Tax Folio // O/y
Legal Description Yt c zaee. 5 S .-- Historically Designated: Yes No
Owner/Lessee / Tenant /2 CJ& , -' 10,E Master Permit #
Owner's Address 5 7 y /ZJ $� Phone 73 --
Co. / tizeo,»,✓�✓ ,,pp ���
Contracting .5 � / Of�w7;.� c� Address 9,75' . / 33 2
Qualifier A l E.P,/ 5 i
State # Municipal #
Architect/Engineer
Bonding Company Address
Mortgagor Address
Square Ft. Estimated Cost (value) i pa ' Q 00
Sign
laws re g construction and zonin
APPROVED:
Zoning
Mechanical
2 (.1.. ")
Notary as to Owner and/or Condo President Date
My Commission Expires: .
FEES: PERMIT YO. SfRADON
4-3 - 0C
ermore, I authorize the above -named contractor to do the work stated.
Date
Plumbing
SS# ' Phone 95 V- 610- 70b/
Competency # 5 4 t� Ins. Co. /j/„
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1A /.✓... �,� %/�i o2 a,� f7'f7 r/S� �-t H — 1.4.9VroE
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 OF 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 th the foregoing information is accurate and that all work will be done in compliance with all applicable
gnature of Contractor or Owner - Builder Date
2- ?D s 10- 9z
Notes As to„Ceantraooror :off I iflt dery
My C is4ipn piteS :..
_ 7.1; 7::
p , �, 5
C.C.F. l JO NOTARY c7 o TOTAL DUE Y7 o ..5"
Electrical
Date
Engineering