PAINTDate
Legal Description
Owner/Lessee / Tenan
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
(� � I C
L9ob Address : iii T( v� Tax Folio
Historic ly Designated: Yes No
Master Permit #
Phone 0,5)751-u.13/
Owner's Address l ' sr:
Duxof
Contracting Co.
Qualifier Phone
State # Municipal # Ins. Co.
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle on : BUILDING .' LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
CI 4- Q- roil o f house_ (Yefc} un
W\\Of 2. 3 11 r i(Yl
Square Ft 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, a
11 certify that all work will be performed to meet the standards of all laws regulating construction
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHAN; : " ^ t
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all wox
laws re construe ' • n and zoning. Furthermore, I authorize the above -named contractor to
r� .\\2,
Flail
o Own
ssion E
Signature of o
Notary
My C
/or ondoPresident Date 0 Signature of Contractor or Owner - Builder Date
co /�-
: ,a. r r gte; Notary as to Contractor or Owner - Builder Date
�! " ����- EM. My Commission Expires:
rre t�ri� °Ca �� ��9'�.:r ���iwJ
Iii E1 gl7P,�
FEES: PERMIT i g RADON C.C.F. w (% NOTARY BOND
TOTAL DUE C
APPROVED:
Zoning Building
Mechanical Plumbing
lofitt5
Address
SS#
Competency #
Address
/
Electrical
-gum (if applicable). I
.aderstand that separate
iance with all applicable
Engineering