ALARMDate Job Address `86 kg q ? l Tax Folio
Legal Description Historically Designated: Yes No
OwT.er/L F1ant- i n / f �J 1 l
Owner's Address f41,- 9 9 , T
Contracting Co. �, bZ-I e_c_u-f; „Is
Qualifier tai c. ( ,4 b S LA
State # 000 (0 3,C Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
1 8 ale-A.)6 c�A
Square Ft. Estimated Cost (value) 3.>1.- .
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 FINANCINti ti ;,
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.
cure of
amardira
. President Date
Ter and/or C
4 ,4.,3 4.1L,„
Notary as to Owner and/or Condo President Date
My Commission Expires:
, g [% 2 0 7 z
''y', CAREEN A. .HUJ SON
:•: �•� MY COMMISSION # CC 6401n
• EXPIRES: May 19, 2001
Bonded Thor
Notary public UndenvtitOra
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
C.C.F.
Competency #
Address
Address
1 1 ob o'bq 0 qv
Master Permit # 4i)., c7/
Phone 3.,0 S - S 0 S
Address IoS3. S.. ao<,Je rL:.a, 424
SS# Phone 305 63-1
Ins. Co.
Signature of Contractor or Owner - Builder
,a
Notary as to Contractor or Owner - Builder
My Commission Expires:
CARE� CHINSON
My COMMISSION 0 CC 648710
EXPIRES: May 2001
:�- PUb9C UndeM to
P f ° Bonded-an NOtar/
NOTARY
TOTAL DUE
Date
Date
APPROVED:
Zoning Building Electrical
Mechanical Plumbing Engineering