FENCEDate 1 9 ; Job Address / 7 / 1 N e 99' 3 ee 7 - Tax Folio /) . / 6. 7, 3
Legal Description( , f NJ , D
Owner / Lessee / Tenant LOV /DES /y. f'DP Master Permit #
Owner's Address / 77 .0g 99 Sh
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Contracting Co. 6 �`J �� 7 Address /0/03 Ned, , S7
/ _ �}
Qualifier prf 1 60Mg -
Phone 2e5" V /
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one ): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION e% o:1) "/ / Ii(o4 . a9•` 7Avoor7`y
, ?/v/n , �P inee- 5" or) 6a o � Ce5Z7ek ea/ y 'ails
�7A Go
Square Pt. / / cc7 71 - Estimated Cost(value) c:204s kx
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
orize the abovemed contractor to do the work stated.
ignature o
Date:
** *
APPROVED:
Zoning
or Condo President
Notary . s o O!rne r - 1 /or CO04 President
My ottc Oa at Lend
/ C. mmib;ori , Ex,pi: cs April 30, 1995
.:d d Thru Maynord Borulire3 An
* * * * * * * * *
Phone / :5 -O557
lO
Si natur- of Contra 4r oz er- Builder
Date / i
11/0/
ry
Not. fi � n
m i nsi �•� d ,
My CaRgAp p.; Expires:
Builder
X
FEES: PERMIT 4556° RADON C.C.F. ( NOTARY TOTAL DUE '% 61.1/
Fire
Other
Building /l ib �►% Electrical
Mechanical Plumbing Engineering
i