ALARMDate ( i C l
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
, A/f 99i�—
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant ' 4 zi-
Owner's Address 4/ S7 Phone ' 00
Contracting Co. I LL SSE Address75 /V&) / q &L
Qualifier // 0 11/n SS # - PhOnd190—qiN20
State CO0G ( Munic' al # Competency # Ins. Co.
Address
Address
/Ler8-
Tax Folio l / 3 .9 6O / 1./l/
Master Permit #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDIN ELECTRICAL L MBING MECHANI AL ROOFING PAVING FENCE SIGN
WORK DESCRIPTIO r ri'ABVAI1O L4 di le 1 J
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.) r
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable) JI
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 9iAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regula g construction : g. Furthermore, I authorize the above -named contractor to do the work
FEES: PERMIT -3f ' ' 4°.1 RADON
C.C.F.
Signature of Contr
Notary as o Con
My Commissio
NOTARY
BOND
TOTAL DUE
(a( - 7F •
Date
Date
APPROVED:
Zoning Building Electrical #W?
Mechanical Plumbing Engineering