PAVING�y PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3-/‘ • 7 / Job Address / 7d Ale 7 71 e/ Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant / /, G4 4 ell ✓Ols/I Avacit /7 Master Permit # 44 2-3
Owner's Address / / 70 , P6 9,6 Syr, -- Phone 3 05/ 7 - 2 741-3 Contracting Co. 7 t� l 1 I)( den 5 16'^l!(t 7 Q,6_ Address
Qualifier C- {rax dD) e ' - r tt41 66,
, � O r �� 9
Municipal # �•- �O 7
Sta #
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ke-514 r7 nc y 0'77i 7 al) Tt 4 / M7
Square Ft. 7J
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IIN YOIIR
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.
My Commission Expires:
FEES: PERMIT
APPROVED:
Zoning
Mechanical
'dent Date
Date
OFFICIAL NOTARY
GLADYS J VILLAR
NOTARY PUBLIC STATE OF FLORIDA
M COMMISSION NO. CC714103
Y COMMISSION EXP. MAIL 1
RADON
/07 (/ S.-'3F
ss# 3Q5/2 �5 2-7f
C o m p e t e n c y # ,F o 7 Ins. C
Address /D 7 //
Estimated Cost (value) 7 °
Si a ture ofCon i ,, r or
Do
C.C.F. NOTARY r
Building
er- Builder
Notary as to Contractor or Owner- Builder
My Commission Expire
• FFICIAL TRY S
GLADYS J VILLAR
NOTARY PUBIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR.
-
Electrical
BOND
TOTAL DUE
No
ate 0' /9,
6 -p 4k
- � %ma
Date
Plumbing Structural Engineer
D a t e ' ' 7 q Job Address X (10 7 NE 96
Legal Description ', / Historically Designated: Yes No
/
Owner/Lessee / Tenant /�/ /c% e/ ai)'L(Z //
Owner's Address /0/ O /7.7 � • 0 5 /C-eL Phone 3 6) 5/ 75 - 2 j
Contracting Co. °'
.� -- - -� �. _ L = -= =�� ==� " Address
SS# Phone 3bS- - c S
Qualifie
State #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /' c p h ALT
Square Ft. A- 1?
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 YOIJ 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 AFFIDA
constructio
otary as to
My Comm
Fo
FEES: PERMIT
i/o
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
RADON
Municipal #
I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
d zo 1' • ore, I auth. • the above -named contractor to do the work stated.
"dent Date
Date
Tax Folio
Competency #
Address
Address
Master Permit # 2-1 4 7 Q .2 3
Ins. Co.
oG
Estimated Cost (value) 729 i
No as to Contractor o
My Commission E
RES JUN
BONDED THRU
ATLANTIC RoNoiNo co..
C.C.F. 6 ° NOTARY '— BOND
TOTAL Di /71D 6 Q
Date
3 -/9
APPROVED:
Zoning Building iqk ( Electrical
Mechanical Plumbing Structural Engineer
•
3
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