STORM PANELSPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date q h � Job Address
Legal Description / - h r �o
Owner / Lessee / Tenant J-/ (T)O ,L,-
Tax Folio 1 i �� g7
Master Permit �� �. -51c✓
Phone ?'
Contracting Co.,5PA /) /g4) V/). J4• Address , ?V /be) d-/// /2/�/1?/ / Y-
Owner's Address 9,0? /I,i.P.
Qualifier 6d,17 ,i,() ,<77,1_ 7r,S SS# Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer J ) ) 7& )//6/7 qiigsec 2 ,DCD . Address / ,,4 /' /4D / /cil)i9 Vi /1l/ /III ..s'/O r -
Bonding Company Address
Address
Mortgagor
Permit Type(circle one)„ BUILDING ELECTRICAL PLUMBING
WORK DESCRIPTION �A VX ,.STM 2 /? ' A 5
Square Ft. / e(
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.
/0 �> G
owner and /or Condo President Signature of Contractor or Owner - Builder
Date: . r
S gnature
Date: y -t
APPROVED:
** * * *
Notary as t • I e rr*
My Commission Expi'
}f/A
DAVID A. LEVINE
' tAA1'(C�1d93i06'aile�C�RES
;dc February 17, 1997
BONDED THRU TROY FAIN INSURANCE, INC.
FEES: PERMIT 1- 1 RADON C.C.F. 1 •
Zoning
Mechanical Plumbing
Estimated Cost(value)
*
*
ac
* * *
Engineering
MECHANICAL ROOFING PAVING FENCE SIGN
p
Notary as to ofit4§tor orwOMOUNBMilder
My Conuni s s ion id.' wa MY COMMISSION N CC260247 EXPIRES
a. �1 February 17, 1997
IONt}46. UTROY FAIN INSURANCE, Ifk%
* **
NOTARY TOTAL DUE ) 1'1 C 15
Fire Other
Building � 0 Electrical