PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address p71/1 F y ,f 4 Tax Folio // /1 70
c.s
Legal Description 60 , l Z Z z 3 Olt- 8 Historically Designated: Yes No
Owner/Lessee / Tenant "Po Master Permit #
Owner's Address Phone ? C 7 - 0 7 1-/-
Contracting Co.
Qualifier
State #
Municipal #
SS#
Competency #
Address
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING
WORK DESCRIPTION n:,,,412„4 tA. La`1 L-J or cam, e
01 1; 4. /4-1778 ) /dc-- / 1 r(
Square Ft. Estimated Cost (value) (-10 O
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT O. O.0 RADON C.C.F. , f0
Address
Notary as to Contractor or Owner
My Commission Expires:
APPROVED:
Zoning Buil
Mechanical Plumbing
MECHANICAL ROOFING PAVING FENCE SIGN
NOTARY L 0
7 J' FG Electrical
Phone
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
X /4
Signature of Contractor or Owner -B
Ins. Co.
uu
ilder
.\1>S1Y P&6 OFFICIAL NOTARY
2 S � C BARBARA ANN FUC :.
is 'b * COMMISCION
� CC3601;;,
`� MY COFaMtss :O;•'
D to
2 / 5 /9
Date
TOTAL DUE
Engineering