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DRAINFIELDDate PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 0 Job Address 11 • ,q757. Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant CL /10 / Master Permit # S Owners Adds / Gi / • q7 s Phone 3S-- 7 g l — o W • Contracting Co. M e!:( S- ,ems S 00.4AI -Z Address 199'52- 4 j,i. ,0 r Jt � Qualifier .I e C • l o c.J£l dd SS# • Phone$$ Mg, s 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 WORK DESCRIPTION l � tr Square Ft. g? ' STEPHEN E COCIYIN(s St 3t© of Flovida My Comm. Ettp: 08/04/01 APPROVED: Zoning Building Mechanical Plumbing Date Estimated Cost (value) /7 e2Y 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 OF 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 con : • i aOning. Furthermore, j authorize the above -named contractor to do the work stated. vv n gnature of Contractor or Owner- Builder OP Date N o t D a t e Notary as to Contra • •, t ' ate My onmmission xplres: My Co ss'>a ` r `� ` tl S 002 FEES: PERMIT ' RADON C.C.F. ( NOTARY � 1 Electrical TOTAL DUE :::;?_)e: . 0 Structural Engineer