ALARMDate Job Address 10 /rE
Legal Description
Owner / Lessee / Tenant
Date;
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
• ,1•e1l1
�Y•
Tax Folio
6
AIL— 2
Owner's Address l" / / 33�i ? Phone
Contracting Co. /1-114 4 Address - - / may,.
Qualifier J7i7Jli7X y SS#/T: -. - Phone 4 42s7"
State 414 0 tk Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one BUILDING �ECTR SAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / % fr .r i/
/.//
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 an MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is acc ate and that all rk will
be dose in compliance with all applicable laws regulating constructio and oning. Fur! ermore, I
auth• • th above -named contractor to do the work stated.
S': atiirr.of"ewner and/ or Condo
resident Signature of Contracto' o s `(Builder
Notary as to Owner. and /or Condo President
My Commission Expires: NOTARY PUI&.IC STATE (11' FL& A
MY COMMISSION EXP. MAY 15,x 5
BONDED MU GENER.ri. INS. UND.
** * * * * * * * *
Date:
Master Permit 41
• Notary aso C qb• � / %Z q� er
My Commission 1x �'{ M Commission Expires
;!��• •• . June 4, 1996
•• ••;rar�dd+• • Comm. No. CC 205953
* * * * * * * **
PEES: PERMIT ;34 RADON C.C.F. t $4, NOTARY TOTAL DUE
APPROVED: Fire Other
".�
Zoning Building Electrical 1'01
Mechanical Plumbing_ Engineering