1996 PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 6 l as cut) s r
Owner/Lessee / Tenant C �.. C L. A41.1 - , >. ` ,g . Master Permit #
Owners Address Phone `IS — k 8
Contracting Co.
Tax Folio
Legal Description Historically Designated: Yes
Address
Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIP'T'ION ei
Square Ft. Estimated Cost (value) # Ott . 00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
I I?SULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING,
CCNSULT 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
'aws regulating construction and zoning. Furthermore, I authorize the above -named con ctor to do the work stated.
Signature of owner and/or Condo President Date Signatur ontractor or Owner- Builder ate
U •e
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder
My Commission Expires: My Commission Expires:
FEES: PERMIT % f4 RADON
C.C.F. "6 NOTARY 4,
No
BOND
TOTAL DUE
Date
AP:?ROVED:
"o
Zoning Building ' Electrical
Mechanical Plumbing Engineering