ALARMOWNER'S AFF
laws regulating
Signature of owner
ICE r e II APIFILIICATI[ON FOR MIAMI SIHIO I'z E@ VILLAGE
Job Address
Owner's Address G 5 �U L ‹
Contracting C ` fl i '✓�
Qualifier F1 / //j - CP
State #r1>O St Municipal #
Architect/Engineer
Bonding Company
Mortgagor
Pennant Type (eirele one):
WORK DESCRIPTION
1
: ' a,., , SLES
of t ^f ; ^ ,1141 % ION ti CC 550094
I : June 4, 2000
' w . Pib!lc Unlnwutters
Tax Folio
Competency #
Address
Address
Address
Phone
FEES: PERMIT RADON C.C.F. NOTARY
Date
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant \ V C (L
Address 74, J 44✓ /rg°
Notary as to r and/or C • do Presiden
My Commission Expires: My Commission Expires:
Master Permit # L 2 1 y
SS# -,.7d? Phone .ilk �- t
Ins. Co.
ING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost (valu-
WARNING TO OWNER: YOU MUST RECORD A NOTIICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMP OYEMi ENTS TO YOUR MOPE i ": TY (IMF' YOU INTEND TO 0 TAW FINANCING,
CONSULT 'WITH YOUR LENIDEvt 0 1 AN ATTORNEY i„EIFORE RECORDING YOU NOTICE u,E 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.
VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
on and zoning. Furthermore, I authorize the above -named contractor t• do th ork stated.
1
Signature of Con
tr .�L -o; 'Oar'
as to ' actor or 0 ilder Date
BOND
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering
TOTAL DUE
Date