ALARMD a t e / - / ( , - 7 , Job Address / / /0 N )c) o .33
Iv), t on
Legal Description Lo± io /C3 / � i 7 f3/ Sec 8
Owner/Lessee / Tenant 4 L cam e sf R e
Owner's Address / / /0 A/ E roe)
+
Contracting Co. C-tJ e
Q ualifer
WORK DESCRIPTION
State # E 1 o c) c o l L) Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Square Ft. Estimated Cost (value)
0 :L 'S AFFIDAV : I •`rt
la i t ' gula ' g . s tion : • on ' g.
/ ( /
Notary, as to 0
gOtfitittissio
APPROVED:
Zoning
Mechanical
inikoCo
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Alf i Y PUBLIC
Aditi STATE OF FLORIDA
`•; ` ' COMM. NO. CC 28388F
My Comm. Expires May 6 IP
FEES: PERMIT 3 ` 'd RADON
nt Dat
/ (o
Tax Folio
1 / - 3aoJ'- ot9 -o 'b
Historically Designated: Yes No
//a__
Master Permit #
Building Electrical
3 'gig
Phone 3 o s -- gto (/ — 6 70
Address 3 - 74o P .- /< cJ' � a 9 tevci
SS# Phone q-70 o goo
Competency #
Address
Address
Permit Type (circle one): BUILDI LECT I CAL PLUMBING MECHANICAL ROOFING
�Ie v ( c es —
Ins. Co.
-
95
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IIVIPROVEMENTS 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.
all the f• egoing information is accurate and that a work will be do - 'n • with all applicable
F . re, I authorize the above -named con
Signature of Contractor or Owner- Builder
PAVING FENCE SIGN
'lder
Notary as to Contractor o
My sctirupissio . NOtARY PUBLIC
STATE OF FLORIDA
' '•' COM • NO. CC 28369F
My Comm. Expires May 5 ' r
C.C.F. / S NOTARY TOTAL DUE 3
Dae
Jra
Plumbing Engineering