PAINTMy Commission Expires:
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 2 0 R N . E, q 9 S TR E-ET)'ax Folio
Date
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenanty PA RI C.K - I - TrQA c . DEVR►•t Y
Owner's Address / ` Phone 6 0 s) 7 s 6- - i SS 2.
Contracting Co) 0 U) h Q V+
Qualifier
State # Munich
Architect/Engineer
Bonding Company ; t l / 04/�
Mortgagor Auaress
Notary as to Owner and/or Condo President Date
FEES: PERMIT RADON C.C.F.
Address
Mt
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
/ ReoF PRESsvRE C_ LEA Ai
WORK DESCRIPTION PAI N; ?n!E OUT IpE of 1-113UsE.
IZ) ✓ 1 I i1/ VJ {- - / 7 (11_1_ W o l 7r__ S T!R y1 wo-► '(L)
Square Ft. Estimated Cost (value) 4 5 00
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.
Signature of owner and/or Condo President Date Signa i e of Contractor or Wider
i , /
otary as to Contra
My Commission E
NOTARY BOND
Building Electrical
•
Master Permit #
3►rs p
Phone
. Co.
311
S�P P1 -1Es
r i
`.
es: GLADYS J VlL LAR
NOTARY PUBLIC STATE OFFLORIDA
COMMISSION NO. CC714103
MY CpjAMISSlON EXP. MAR. 1
TOTAL DUE
26 4P q9
Za pate
ee - 2- - 77
Date
Plumbing Structural Engineer