PAVING•
Date
Legal Description
essee / Tenant
Owner's Address
Contracting Co.
Qualifier , �/�! /
Z Phone
State # ----- 1 -- Municipal # ,04 # Ins.Co.
Architect /Engineer //i-- Address
Bonding Company j/7) Address
Mortgagor � Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFI
WORK DESCRIPTION ,f' (,,C/ c /t(� • [ /f / /��L /�
Square Ft. 9
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 =nd ; ning. Furthermore, I
authorize the above -named contractor to do the work stated.
/
S gnat ffe of owner and /or Co •o President
Dat-:
N•t -ry as to
My Commission
E
** * * �"f
FEES: PERMIT C
APPROVED:
Job Address
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
//C iL / da- -c-/ Tax
�f Rik , I0%
/5- / /,G ,'c-J / C
// /l� ,ve /O7 sJ
/i4 /2
.
i(/ v
Bonded By Service Ins
vi CC342206
main * 11l
RADON
Mechanical
*
C.C.F.
Fire
Buildin
Folio
Phone
Address /9575x/. // ,4"
Estimated Cost(value)
*
Notary as to
My Commissio
*
I/ 3205 11 &1503,
Master Permit 1P 35 1 1/
NOTARY TOTAL DUE
ENCE SIGN
Owner- Builder
Bonded By Service Ins
No: CC342206
Man I10
* * * * *
**
Other
Electrical
Engineering
SECTION
S 5"3 -='..)
SCALE
,ALLEY
s�
LOr 9 •
BLK /71
}n.1 N E STREET NOUN MIAMI, NIORMDA
.SHEET
/of /
ATLAS /9I- /2
. .PgS 11237
,(/ R/W
P,:. Al 0 ...5::="Pvi‘E ,sz:/.7v
/ l2 O /OD f'° o_FT,2eE r
J. o./- S3995
A.F.E. /771 /CCU/