FENCEDate
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
C Job Address c `r - ' ! T Tax Folio
Legal Description Historically Designated: Yes No k
Owner/Lessee / Tenant X )05i // 2 i ,4 ' i /) Master Permit #
Owner's Address ? ( A-1G e 5 4„ Phone ? F?- - ? )-1)
Contracting Co. 5eL P Address
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Address
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING
WORK DESCRIPTION ( fi} I c-,/ irk/ Fe
Gt1GL y
Square Ft
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 contr a for to do - w. ' stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date of
MyRss*E4iN NOTARY
RA MMONTIEL
* COMMISSION NUMBER
'r CC401261
9lk QU O MY COMMISSION , EXP.
OFF\P AUG. 17
My Commission Expires:
FEES: PERMIT
RADON
S
C.C.F. t NOTARY
Estimated Cost (value) 3C!
0
3 ?S s�
SIGN
Contractor or Owner- Builder Date
TOTAL DUE ' v
75
— 2Y Ca
Date
APPROVED:
Building U
g
Mechanical Plumbing Electrical
Engineering
Zoning
JO:: . MOORE
R gistered Engineer #133
Registered Surveyor #55
STATL-..OF JL RI L
do, e 7:5.
/0.05'
•
9/6!
h
Ns.. ai 0
N.
h
75
f
2o. 03
One Story C.B.S. Res.
0 847.
24.3'
The above 'SKITCE OF SURVW was revised on July lath, 1953 to ahoy
location ot_ building. For'
der #32751 Meredith G. Johnson and Dorothea . C. Johnson, his wife.
B.Y #1042 -49
WE HEREBY CERTIFY::- That the above "SKETCH OF—SURVEY". has been revised
- this
20th day of October, 1955, and is' true. and correo.t` ..to the best ()tour. know—
ledge and beliet
_, BISC NG COMPANY
/7.4'
. 14
Pipe
9.8' r e
31679
I mo.
t was
PrP e
edge o f
sok..09 P
_. Sc9 /e' /? . 20.'
President
'