BUILDINGPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Date � / /hJobAress l �� .'YG % T � qax Folio ' ' ^ ' `
Legal Descriptiot Zo' .3 .3/( 80
Owner/Lessee / Tenant
Owner's Address 221p A ff, /(04,.
Contracting Co.
Qualifier
State #
Municipal #
Historically Designated: Yes
Master Permit #
Phone q SCS - io66.7
37 A/F /3ri 5-
SS# Phone
Competency # Ins. Co.
No ✓
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one) BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
/we /L��S -4- -4- ,., / •
a
WORK DESCRIPTION C % � � (L� A /� /( � ' 1
Square Ft. Estimated Cost (value) 71., /5 b_,
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 . . one in compliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do will
stated.
Signature of owner and/or Condo President Date Signature of Contractor or Owner- Builder ate
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder
My Commission Expires: My q etrEacp es:
FEES: PERMIT VO• 00 RADON
APPROVED:
Zoning
Mechanical
C.C.F. / o o NOTARY 0
anklina I
Electrical
TOTAL DUE .4 7/6 . O
Plumbing Engineering