PAINTPERMIT APPLICATION PPLICATION FOR MIAMI SHORES VILLAGE
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Date / Q ; .]
Job Address J 4 /,-(E g S .Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant 4 /( i - k(t c Master P 't #
Owner's Address 113y ` U G/ 5(e/ Phone -36 7/ J '1 /( i
Contracting Co. Cu !/U. F IR__ Address
Qualifier
F
" SS# Phone
State # _ lviunicipal # Competency # Ins. Co.
Architect/Engineer c Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION v /1% f e' ! 7 t
Square Ft. Estimated Cost (value) gov
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 Signature of Contractor or Owner - Buil Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder
My Commission Expires: My Commission Expires:
FEES: PERMIT tic). RADON
APPROVED:
Zoning
Mechanical
Building
C.C.F. NOTARY
-5 (i)if&
Electrical
TOTAL DUE
Plumbing Engineering
S= 9
Date