FENCEPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 6"1 - 9.3Job Address /97 /1/1= 99 ST Tax Folio //'306- 013 - a/4)D
Legal Description se C %' C.'t (of 2t0 + Lok a I M % 4rnt s‘‘
/ Lessee / Tenant X 1 Y "\V.r Y \ INSIR Master Permit # :31,7
Owner
Owner's Address x 810 St.). 6 Ame, ?Ign {gkto' ft 33317 Phonex 305 52 7030
Contracting Co. O!2 P 02 Address .C'A-ryn t=
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING SIGN
WORK DESCRIPTION /0 TN f? A 6 � e i , �nal-' /- cc CA? '2a.es1 ? - ✓vd
a c k 'o V, 4-4 Tom, A 's
Square Ft. Estimated Cost(value) ( Re)
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. r 1. DA-. ISa5 040 -'i) 4v1 0
E*9.
Signature of owner and /or Condo President Signa ure of Contractor or •.• - Builder
Date: Date ?u^ a 440C3
__ 41111,... 9
Notary as to Owner and /or Condo President Notary) as tt • • .actor or Own - r- :uilder
My Commission Expires: My Coission Ea t aP ublic, State of Florida at La. ,e
My Commission Expires Dec. 18, 1995
Bonded thru Huckleberry & Associates
** * * * * * * * * * * * • * * * * **
APPROVED:
Zoning
FEES: PERMIT ' 30 $ 1° RADON C.C.F. .00 NOTARY TOTAL DUE-A
Fire Other
Building Electrical
Mechanical Plumbing Engineering
•
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o 99 6 7
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