PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date t a " A .?7 Job Address Kb / . r 7-i t Tax Folio
Legal Description 10 M E
Historically Designated: Yes No
Owner Vvj1� , l � /V E t Ci /R Master Permit # 1- 1S - 94 ° J
Owner's Address 1 CI 0 it l: 1 r Phone
Contracting Co. (r ) \de--/ ,t.(r' A- 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 DESCRIPTION O
Square Ft. Estimated Cost (value) , f 5-60,
Signature of owner and/or Condo President
APPROVED:
Zoning
Mechanical
Address
Date Signature ofQextaetor or Owner - Builder
FEES: PERMIT RADON C.C.F. NOTARY
Building (y_ h Electrical
3oc= 7s ¥ -0/-/ 90
tokt. 4,46
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.
Date
Notary as to Owner and/or Condo President Date Notary as to Contra
My Commission Expires: M Co �/ � OF1q� 11Q
tc.,,
!-� 0 4r"' '� FRtAi� r
_ Q CC797277
`c OF f` DEC. 1 200
BOND
TOTAL DUE
Plumbing Structural Engineer