The URL can be used to link to this page

PAINTDate 2e>-9 Address E,(, zel 9/,57 Tax Folio 1 1 32-0(o 1 '6&) 0 Legal Description LCD 1 P O Ck- H 4 ' ‹' (1.-• l 2 / Lessee / Tenant MAJ /e/ Q v /�G� Master Permit # J(O ©5 ? Owner's Address �0 .� �� . � / /' Phon &) 7 `r 7 - ' 7 76 5 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Contracting Co D W Aje 2 -- Qualifier A)/14 ignature o Date: Notary as to Owner and /or " Condo My Commission Expires:3I/98 ** * FEES: PERMIT 57.'511 RADON /L- A- Address SS# Phone State # Muni ipal # Competency # Ins .Co . Architect /Engineer � icy/ ' A ' 0 II Bonding Company dress Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION �� Jjil /� J t`��r_ 4C1� -�5 ��A'7 MIS /J, z° �� 4") / UjO Square Ft. Estimated Cost(value4Qo C7.-gC7, 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 al applicable laws regulating construction and zoning. Furthermore, I autho e abo e amed ±tractt o do the work stated. or Condo President President S PRY P!/ OFFICIAL NOTARY SEAL o 7 . <� BARBARA ANN FUGAZZI it .. k e µ `0 * COWMISSION*NUMBERt 'R Q CC360191 7, car ` e MY COMMISSION EXP. OF F APPROVED: Fire ''' Other Signature of Contractor or Owner- Builder Date: Notary as to Contractor or Owner- Builder My Commission Expires: TARY TOTAL DUE 1tth Zoning Buildin_ " /r4/ V Electrical '� Mechanical Plumbing Engineering 1