ALARMDate
a/
Legal Description
Owner / Lessee / Tenant
Owner's Address /
Contracting C
Qualifier
WORK DESCRIPTION ��
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address '7 4 )
-57
5.■
4 AM '
Sig n • 4 fi • /Gi t o esident
Dat
•
« x ' : ✓� 4, 1996
o CC 9 )' Q%
Notary as %foi and /or Condo President
My Commission Expires:
Mr1C r :i5 0 ' :_ :wires
r
Tax Folic 4( 420.5 2t'5' 0
0
Master Permit #� -��O
. Phone
7c23
SS4f ✓ ' , Phone Ft
Address
State l- T <'/ unicipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): Bp,LDING E.'fRICA PL G MECHANICAL ROOFING PAVING FENCE SIGN
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 a MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is ac rate and that all work will
b done in compliance with all applicable laws regulating constructs a•• zoning. Furth ••re, I
t _ - riize the above- med contractor to do the work stated. /
Signature
Date:
- Builder
ra F
• JULIO R.: LES
« � 4 Y Co, is fxflires
***41t 11496
Notary as Mg: rfeen Bi- Ms?4ff9bilder
My Commission Expires:
** * * * * * * * * * * * * * * * **
3
FEES: PERMIT, V,r9 V RADON C.C.F. r !' NOTARY TOTAL DU
APPROVED: Fire Other
Zoning Building (ectrical
,i
Mechanical Plumbing Engineering