PAINTDate �� 1
PERMIT APPLICATION FOR MIAMI SHORES VILLA
Job Address Tax Folio
Historically Designated: Yes
Legal Description
Address
Address
Phone � 7 /4,
Square Ft. Estimated Cost (value) ''><
4
Owner/Lessee / Tenant Master Permit #
Owner's Address
Contracting Co.
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 DESCRIPTION)/ /Nir, e C 40—SE
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN T YOU"
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUF LEND F.,
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 wor :c
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatin3
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
FEES: PERMIT RADON
Signature of owner and/or Condo President Date 'Signature of tractor or Owner -Buil . Date
C er .f" s ����
. -c,"
Notary as to Owner and/or Cando President Date Not as to Contractor
My Commission Expires: My Commission Expires:'\ A/1 CC`�w1
C.C.F. NOTARY BOND
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D ate
APPROVED: TOTAL DUE
Zoning Buil WI l Electrical
Mechanical Plumbing Structural Engineer