PAINTOwner/Lessee / Tenant L l' / Master Permit # 3 18 2,$
Owner's Address /0?....0 6 X E —5 Phone £ 7 ? — 6 7 , "—
Contracting Co. 0 c¢o ,(E)- Address
Qualifier SS# _ ne
State # Municipal # Competency # _ To.
Architect/Engineer Address
Bonding Company Address /
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION / F / O 4- ed/ Ls
Square Ft. Estimated Cost (value) ,.ss SD 0'
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Signature o ow ner and
Con do President Date
, /
Signature of Contractor or Owner- Builder
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Notary as to Owner and/or Condo President Date Ifotary as to Contractor or Ow ne gr --�
My Commission Expires: My C xp�{es ; s taw/
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Date
Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Data S Job Address // G }4E S U • - Tax Folio
Legal Description Historically Designated: Yes No
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.
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FEES: PERMIT L(64 RADON C.C.F. NOTARY (r' TOTAL DUE yQ
APPROVED: 4t
Zonin g Building Buildin / Electrical
Mechanical Plumbing Engineering