BUILDINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 2/4/2___ Job Address y 7f cP 7)c • q5 / _ Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant l ?
7 k, 9 Cj Phone
Owner's Address
o ev
Signature of owner and/or Condo President Date
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON C.C.F.
LtIo
Contracting Co.
Qualifier
State # Municipal #
Address
SS#
Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): (; ELECTRICAL PLU I BING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
t
Square Ft. w 0 Estimated Cost (value)k 6 Oc o
Address
UILDIN
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.
Contractor or Owner- Builder
4 016 2 '�
Notary as to Owner and/or Condo President Date No : as to Contrac • •
My Commission Expires: My Commission E • es: OFF C n .11 ARY S
GLADYS l VILLAR
.ARY PUBLIC STATE CF tWT!DA
COMMISSIOAI NO. CC714143
MY CO�di�1IST.O ti E ?. MAIL 1 2002
NOTARY
Electrical
Master Permit #
BOND
Phone
No
TOTAL DUE
/ — /j
Date
c
Date
Plumbing Structural Engineer