PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 9/a3)96 Job Address 10 to' /V E ? Tax Folio
Legal Description Historically Designated: Yes No V
Ow ner w n Lessee / Tenant AA- R I E. I l° B Sod
Owner's Address
Contracting Co. (r) t ,,;
Address
Master Permit #
Phone 5 cl " ? ‘ l 3
l
s
4 t
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION a 1 S1 'WO U S ie t n 5 -e t^ oz.) 1, t t`2,
J47.A- /TF uv/ -{"7
Square Ft. Estimated Cost (value) 0 6
WARNING TO OWI
RESULT IN YOUR P;'
CONSULT WITH VC
Application is hereby
certify that all work
permits are required ft
OWNER'S AFcIDA'
laws regulating ' :ons:'
9 3
,ignature of owner and/or Condo President Date Signature of Contractor or Owner- Builder Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date
My Commission Expires: My Commission Expires:
FEES: PERMIT A l9 RADON
APPROVED:
Zoning Building
Mechanical
' A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
+.NTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
X BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
- rid installation as indicated above, and on the attachea addendum (if applicable). I
Ls of all laws regulating construction in this jurisdiction. I understand that separate
i, POOLS, ROOFING and MECHANICAL WORK.
unction is accurate and that all work will be done in compliance with all applicable
Itnorize the above -named contractor to do the work stated.
C.C.F. ArD NOTARY BOND
e)-7. 67(2_3/7,6
Electrical
TOTAL DUE
Plumbing Engineering