ALARMDate 93
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address /049 r //E
Tax Folio 1/ -,3)__o - 3 700
Legal Description C t // )L 0 A- L / a // / /ice I C1;44 See__ 3
Owner / Lessee / Tenant Master Permit #
Owner's Address c A/E ?4,-C Phone
Contracting Co. ' /f°" 1- P24:" /r/ )rd JoQicfi,2 Address 2.40,0 �1 ��►�e , "�j ��
Qualifier ;;Art Py » C1-- ss# /
State #t OOO i Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDIN(CELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION q4c) I 21
Notary as to Owner and /or Condo President
My CoMM14.ysp :FLORIDA
MY COMMISSIO'i C.;;.' :,EPT.29,1994
I ONDED THnU INS. UND,
** * * * *
647-
/ k 2f3 De h
Square Pt. Estimated Cost(value) � 7 �, d - v
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.
Signatae of own`'r and /or Condo President
Date:
Cl-
=0 �G
Signature of Contracto r Owner- Builder
Date: //- 93
CT;;%7 GiCe
Notary as to Contractor or Owner- Builder
My Commission Expires:
NOTARY PUB ?::,;t: c; FLORIDA
MY COMMISSI:!'1 ;7;;? SEPT.29,1994
BONDED THrtU l'E.;.Jr: / INS. UND,
* * * * * * *
FEES: PERMIT = ;' c> RADON C . C . F ._r NOTARY TOTAL DUE °9 S 3O
APPROVED: Fire Other
Zoning Building Electrical 1 )1);',/ 94
Mechanical Plumbing,
Engineering
* * *