PAVINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address 7a4/6, 7 f/ ' Tax Folio"- 3 L'.4 - O /3 076
Legal Descriptions f 4/ 4- 5 , 6l614t Historically Designated: Yes No
Master Permit # .378 aO
Owner/Lessee / Tenant C.__ L Az At/ 7
Owner's Address 7 0 V, fi , 9 7'... Phone 7.5 — g335-6
Contracting Co. Ot.A -"AJ = 1 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 FENCE SIGN
WORK DESCRIPTION '% \) 2.. 0 �
Square F9 T 9 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, 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 zonin : . Furthermore, I authorize the above -named contractor to do the work stated.
gnature .r owner an Condo President Date Signature of Contractor or Owner - Builder Date
Notary
My Co
7
FEES: PERMIT
cbeifr
r and/or Condo President Date
}1�Y1
EacyntItEF1CIAL NOTARY SEAL
`f e% SANDRA M MONTIEL
* COMMISSION NUMBER
', "''Z .. Q CC401281
F MY COMMISSION .EXP.
OF fk- AUG. 17 1998
RADON
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
C.C.F. 5 NOTARY C TOTAL DUE 1
APPROVED:
Zonin g Building i ( i 15 Electrical
Mechanical Plumbing Engineering
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F \P
SKETQ i OF SURVEY
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14.0'
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1
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 5' / -96) Job Address 70 A t 6 91 ST, Tax Folio f l3 c 2 047 0/30760
Legal Description to' 41 I- F y L p7 S 3L 1p Historically Designated: Yes No �l
Owner/Lessee / Tenant 0 1 / 4 -Z Y'.Q -'Y L Q\ 0..v\ Master Permit # F ? 8 7
Owner's Address 7 0 A .) e. Ct 1 �� ' Phone 7 S� j - 6} 3 s �p
Contracting Co. Q cc, J�/�1 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 AVING ENCE SIGN
WORK DESCRIPTION C3•,V NA Q'� l.�
Square Ft. Estimated Cost (value) g E7 O O 0
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.
ature of •' er and/or ondo Presi • ent Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
Notary as to.Contcactor
My CommissionExpires: ' t'rrre. s :k
`aT L
s R
Electrical
on tractor or Owner- Builder Date
s /r,6
Date
FEES: PERMIT 'Va. o-o RADON C.C.F. _ NOTARY o O TOTAL DUE ,r-1
APPROVED:
Zoning Building
Mechanical Plumbing Engineering
FA.?
0
0
iP
•I•
SKETCI! OF SURVEY
scale 1"=20'
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3 ey.
1 /
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0 , k•-1^.' 7.00.
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