FENCE.4
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 70 /V, , / j �r r Tax Folio// 7 06 D /3D 7l c.,
Legal Description 1 Historically Designated: Yes No
Owner/Lessee / Tenant 0 C_,) .42-A ^ Master Permit # 3 / .�
Owner's Address 7 P7 Ni 4' 9 74 T` Phone 7,'/ — g 3 .5-47
Contracting Co. Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING
WORK DESCRIPTION
Square Ft.
My Commission Expires:
7,„0
FEES: PERMIT t1 RADON
C.C.F.
Estimated Cost (value) ,5 75", 6' 9
mss.
SIGN
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.
and/or Condo President Date S' at a o f ontractor or i�vner -Bur Date
Signature of owner an yr,
Notary as to Owner and/or Condo President Date Not as to Contractor or Owner-Builder ... Date
My Q O"1fi$e lA!_ NOTARY SEA! R
7,T (� SANDRA 1N MONTIEL '
. - * COMMISSION NUMBEP
Q' CC401261
om' Q MY COMMISSION EXP
�.., r k AUG. 17,119F
I NOTARY / TOTAL DUE l "'/ 1 4 0
APPROVED:
Zoning Building �q Electrical
Mechanical Plumbing Engineering
3
SKETCH OF SURVEY
scale 1 " =20'
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