PAINT PERMITjg / C , %r(. Tax Folio .7 . i J3 &2
Date Job Address f
Legal Description s /5 '/2 /6 � ` d � -S��% ��b
/ Lessee / Tenant "L�✓ /, I �/ ' Master Permit #
Owner's Address //C 9f Phone 75' 9
Contracting Co. Address
Qualifier SS# - -
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMING , MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Square Ft. Estimated Cost(value)
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 c ractor to do the work stated.
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
* *
FEES: PERMIT ,�/2 RADON C.C.F. 50 NOTARY �`t TOTAL DUE
APPROVED: Fire
Zoning Buildin
Date:
Notary as to
My Commission
Phone
a ,
of Contraetor-o- Own r- Builder
•� rac 0
1 w DAVI
1 Tr ,�1 C W DAVIS
y - . COMMISSION NUMBER
y� a CC255237
• � ` MY COMMISSION EXP.
OF
__. : - ! 2 6 1907 **
Other
Electrical
Mechanical Plumbing Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date DA `0 0 Job Address 2q N E `1 ?j ST Tax Folio A4 - 32 — 6 - ► 3 - 112
Legal Description M IoM 1 51415 (tZs Sect MAD P6 Historically Designated: Yes No
) 0 —1 o. LoTE Is cf w 1/ OF LoT 16 6Lic, 8
Owner/Lessee / Tenant L. 1 Nt " t N/ Master Permit # 477l7
MA,14M 49.4 G{-(
Owner's Address 9- 4 S LAKE, NY) CA3 -AS O(L . 5 3 31 y t) Phone SOS' 34 5 S 5 v 2
Contracting Co. ttWK191
Qualifier SS#
State # Municipal # Col
Architect/Engineer 1
Bonding Company
Mortgagor Ad
Address
Square Ft. Estimated Cost (value)
ills,..,., •
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION f "r
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 perfonned 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. Furthenno I authorize the above -named contractor to do the work stated.
/00
FEES: PERMIT
0 RADON
APPROVED: O 7/y
c
Zoning C � Building
Mechanical
1)* 00
1)1 3SO - S O 4 Y3 - -D
C.C.F.
Signature of Contractor or Owner- Builder Date
a V
Notary o Owner and/or ondo ' ~ "' > •; Notary as to Contractor or Owner - Builder Date
My Conunission Expires: GLAI STATE My Commission Expires:
Y P ,NOTARY PUBLIC STATIS OF FLORIDA
COMMISSION NO. CC714103
IlYCO'�! ION EXP. MAR. 1
60 NOTARY v BOND
Electrical
TOTAL DUE O
Plumbing Structural Engineer