PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
i Date _ S Job Address 991y A/9 sii. Tax Folio
Legal Description
Owner / Lessee / Tenant rn & Y i 1& C,. Er i Master Permit # - 3 . 7q6. S
Owner's Address . 5(1. 14.1. ei Phone 7S 31 /g
Contracting Co. 141 e% Address
Qualifier SS# - - Phone
State # Municipal # ) tency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Pt. ■ 10,0
Pa.
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 Signature of Contractor or Owner- Builder
Date: Date:
Notary as to Owner and /or Condo President
My Commission Expires:
No .. o f Xtrfi6f !MAL
My s s' pn shim es *ONTIEL
» , COMMISSION NUMBER
a CC401261
** * * * * * * * * * F o PAY oinuss N EXP. * **
v Off` AC o U 7 ;ice � * 1
72 r FEES: PERMIT RADON C.C.F.. �� NO ARY � ` TOTAL DUE
APPROVED: Fire
Estimated Cost(value) oi4 -
Zoning Building Electrical
er- Builder
Other
Mechanical Plumbing Engineering