PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date3 57q) Job Address
// l/ ®/ (/ / Tax Folio 1, 5.7W/1 �/�C�O�
/ 7 7 i � °,
weer / Lessee / Tenant 9 / NN(J 1/<s +.x9 Master Permit 4 _3(f'/
'Owner's Address f ( ) e ) i ✓ C " - - (d( ' / , J /i A E Phone 75 % —rt.-
Contracting Co. r ~/!/ Address
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): B LDINQ ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
W ORK DESCRIPTION ti � . e
Legal Description
Square Ft.
Estimated Cost(valuer''&) 0 I`
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:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * *
APPROVED: Fire
i tar has to Co
* * *
FEES: PERMIT 1/417 RADON C.C.F. r,0 NOTARY
Signat, o Owner- Builder
Date: ',67,.3
y Commission E p
•
JOSEPHINE CHURCH
Calletenr6.1
Na CC19756
**
TOTAL DUE 4(1
Other
Zoning Buildin_J Electrical
Mechanical Plumbing Engineering
g 7, 5---
5 -.--.
17(-1 0----
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
ate (O ( a 19( Job Addres 820 QV 6 (C(
Legal Description 6 / 7 7 n c ifi a e / V
Owner / Lessee / Tenant 9 /JV (S ` s. „0_ (,
Owner's Address
Contracting Co.
Qualifier
State #
Architect /Engineer
Bonding Company
Mortgagor
Signature'
Date
Notary as
My Commiss
* *
•
to Owner and or on•' •r
ion Expires: 1C / /bp
PERMIT FEE: APPROVED:
Zoning
Mechanical
Fire
Building
Plumbing
Address
SS# - - Phone
Competency# Ins. Co.
Address
Address
Address
Tax Folio rf 3 nob / 9 ® Jjo
Master Permit #
Phone 7S
Permit Type (circle one): BUILDIN ELECTRICAL P ING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
b
Square Ft. Estimated Cost
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.
c. Owner and /or Condo President Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * 04i)
Electrical
Engineering
*