34469Date‘
Legal Description
?►E,RMIT APPLI
essee / ! Tenant /u/ u•K f
o a y , iG
J
Owner's Address
Contracting Co.
Qualifie
State # Municipal
Architect /Engineer
Bonding Company
Mortgagor
Square Ft.
£b Address GO .9�� /
� �s��7Tax Folio �f��OC ��` 1 /��'
1
Signature of owner and /or Condo Pz sident
Date:
Notary as to Owner and /or Condo Prl sident
My Commission Expires:
Mechanical.
*
*
FEES: PERMIT p, 6 RADON
APPROVED:
ATION FOR MIAMI SHORES VILLAGE
' ifiy- 7 o
Address
* *
Zoning Building
Plumbing G
gnatuc�fe
Date: Gs ,
[ Yt .. Master Permit P# .3
Phone 'ZS//
G 7 * hone PG' i 1
mpetency #/ 7 ? 7 Ins .do.
Address
Address
Address
Permit Type(circie one): BUILDING; ELECTRIC '' MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTIO _ � -: I � .� /�" �` ^ P�4
A G° G
Estimated Cost(va ►. e � 4 O P.2
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, CONSULT1WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obt
on the attached addendum (if appl
standards of all laws regulating
permits are required for ELECTRI
n a permit to do work and installation as indic
cable). I certify that all work will be perfo
onstruction in this jurisdiction. I understan
PLUMBING, SIGNS, POOLS, ROOFING and MECHANI
OWNER'S AFFIDAVIT: I certify that the foregoing information is accurate and t
be done in compliance with all applicable laws regulating construction and zoning.
authorize the above -named contractir to do the work stated.
►f •n ractor or U
? ".
Arne
to Contractor ctor or
Notary as t n a r- Builder
My Commission Expires:
C.C.F. Ira NOTARY
Fire Other
1� p.� Electrical
1l Engineeri
TOTAL
ted above, and
d to meet the
that separate
WORK.
t all work will
Furthermore, I
er- Builder
**
DUE P0646