ALARMPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date PI lq !46. Job Address '53 ALE 9 6 5T Tax Folio 11 3 a, 0 1 q, .28020
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant ,Z.!}ulRFNGE 5404o
ff 04o
Owner's Address `'Y 10, E, 96
C o n t r a c t i n g Co. . * I 1 SL (-cc R 7 CJA/ /E Address A 9a Al 'F- "05' ' 7&
Qualifier OSC#42 402,
State # E,O Municipal # Competency #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING LECTRICA PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 7A05 /On /9/nom / s ' '
Square Ft. 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 th
laws regulating construction and zoning. Furthermore, I authorize the above nam
Signature of owner and/or Condo 'resident Date
Notary as to Owner and/or
My Commission Expires
FEES: PERMIT ' RADON
57'
p f Elater id
pp1M Exp :06124197
Cnmm# CC2974
SS# /5;' -60Z1
rfirreO '7;i or Owner -Buil
,
Notary As
My Commi
1 work wil - done in compliance with all applicable
tractor to do a wor
■•■-■ a
C.C.F. NOTARY
Master Permit #
Phone '7S6 06 s 7
�f ' • 1, c , MVVw °wb'i vi *NVV
A C FERNANDEZ
• el Flom e
297419
Ins. Co. '4o7464
BOND
TOTAL DUE
I/fe / ?r
Date
Date
APPROVED:
Zoning Building Electric
Mechanical Plumbing Engineering