DRIVEWAYDate Job Address g73 Tax Folio
Legal Description le, 1 g 3 /8 AtOC 4/ 42i4. S,✓c f
Owner / Lessee / Tenant - 6 ?" 0 U S Master Permit #,51V7,5
Owner's Address :55 /4/C 9 `/ 5 % Phone ,5 59 3 0
Contracting Co. 6/,5 OA Address,SbOd ,sue/ g ST M - q
Qualifier � SS# / - Phone es2e9 7 l 7
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
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
WORK DESCRIPTION Az - 5 /P /9CE ,2 C
/` .77 /q5 7
Square Ft. 9.C>C
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 regulating construction and zon'ng. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President Si at of Contractor or Owner- Builder
Date: ate: 7. 9/93
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * * * %7
FEES: PERMIT •/ /.5 " RADON C.C.F. , J NOTARY 5 t2' TOTAL DUE Ora
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Zoning
Mechanical
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