PAINTDate *el t, 2, 1`1 Job Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
2`6 nl£ 5 5 r.
My Commission Expires:
Notary as to Owner and/or Condo President Date
Tax Folio
Legal Description — WO u 5e Historically Designated: Yes No ✓
Owner/Lessee / Tenant cOti n e K- y l aft t L am 4 ill q Master Permit # 4/ f c
Owner's Address 1 4 0 i 1 5 - T - . Phonk365J75 7- 3 2 Z 7
Contracting Co. Se L, F /ot»U e o--- Address
Qualifier SS# 7' T
State # Municipal # Competency i, c
Atthitect/Engineer Address
Bonding Company Address
Mortgagor Address -
Permit Type (circle one) BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ?A i r1T E jos-4 U or -Ho m 2
-mg— ," £OFF27
Square Ft. Estimated Cost (value) -14 5
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.
ctor or OwgerB r Date
Notary as to Contractor or Owner- Builder
My Commission Expires:
FEES: PERMIT 7D RADON C.C.F. NOTARY BOND
Date
TOTAL DUE L /,'. '
APPROVED:
Zoning Building /�� �' � Electrical
Mechanical Plumbing Structural Engineer
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address .`We) AA"
" 9'9S7' Tax Folio
Legal Description Iv i a . .. 6 • ' iamb 0 ID • 7 o / 0 V2- of
Owner / Lessee / Tenant - EMp t / L C_On 4 Master Permit 0___32.1_
Owner's Address J l S ) NE /54 7 .Lf. Phone
Contracting Co. e..34) DL Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION I(1 S�C�� p[��5 � ,{(}fir )I4-d / . po sh
„ cJvi(S/ 2,-,/,‘( raves- ,1).014 Mrn1S..Sled e. 1L
Square Ft. Estimated Cost(value$ /60
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:
APPROVED:
Zoning Buildin
Mechanical Plumbing
Signature o
Date:
Notary as to Owner and /or Condo President Notary = P P (9 ® ktbtdO *
My Commission Expires: My Co i ?s: i •��� sn�Ngq� M MON7IEL
N �� �SI FISS ION N t ri
a a.�Ir.:. O __
�' .rc. MY COMMISSION
AUG* 1711104
FEES: PERMIT 17 /d RADON C.C.F. d NOTARY
ractor or Owner- Builder
Builder
* *
TOTAL DUE 1
Fire Other
Electrical
Engineering