FENCEMy Commission Expires:
FEES: PERMIT C>
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Date , % 1 Job Address Jmt // /�_ '1
acs �� a x Fo 0
Legal b 'ption r 9b 1 AF I jail 0 0 I� " Histo tally Designated: Yes No
Owner/Lessee / Tenant ,� v� C 1- }1414 - ('.t fi lk j� 0 Master Permit # �ls S2
Owner's Address YC S '95 ro/ S7 Phone 5 ,5 s.
Contracting Co. D u/y1 `r° r — Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
• Bonding Company Address
Mortgagor
PERMIT APPLICATION 1 R SHORES VILLAGE
Permit Type (circle one): BU I �!�/ EL PLUMBING MECHANICAL ROOFING PAVIN
WORK DESCRIPTION t O ` / Y r e e 1
Square Ft. Estimated Cost (value)
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 regulatin: construction and z. .r g. Furthermore, I authorize the above -named contractor to do the work stated.
Signature 'of owner . d/or (rn• o President Date Signature of Contractor or Owner Builder Date
Notary as to Owner and/or Condo President
RADON
APPROVED:
Zoning Building
Mechanical
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
6/411
Address
C.C.F. . ,C NOTARY BOND
TOTAL DUE AS
Electrical
SIGN
Plumbing Engineering
5502 N.W. 7TH STREET, SUITE 202
MIM k fLOPIDA 33125
TELEPHONE: (300) 220.3171
FAX: (305) 551.1022
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