PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date S Job Address 15 n £ 91 st Tax Folio
Legal Description Historically Designated: Yes No 1e
Owner/Lessee / Tenant 44 /, ' ` ' Master Permit #
Owner's Address g / c /1 " E - ` q Si -
Contractin Co.
Qualifier
State #
Municipal #
Architect/Engineer
Bonding Company Address •
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION /4'eZ50' As
Square Ft. Estimated Cost (value) G'`C
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 contractor to do the work stated.
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT "t(J r RADON C.C.F.
SS#
Competene,
Address
APPROVED:
Zoning Buildin: r •r " 9 Electrical
Mechanical Plumbing Engineering
Address
Phone 72-Z-
Phone
is. Co.
ature of Contractor or Owner - Build
Notary as to Contractor or Owner- Builder
My Commission Expires:
x
S/ j9
ate
Date
NOTARY ' TOTAL DUE 1-/5'