PAINT PERMITADDRESS OF FILE REQUESTED:
INFORMATION REQUESTED:
Acknowledged b
FILE RETURNED TO: INITIAL
Miami Shores Village
Building Department
10050 NE 2 Ave, Miami Shores, Fl 33138
Tel: (305)795 -2204 - Fax; (305)756 -8972
PLEASE PRINT
DATE: TIME: 3 ro
NAME OF PERSON REQUESTING FILE:
SKA
�f I t e l2v-w� u
PHONE #: 1S 1 SL T 6OUR ADDRESS: t 3 10 06 (01 5e
1 i n E S-4-
Trri
Co C—D
I understand that all documents in this file are property of Miami Shores Village and
that NO documents may be removed from this file. You may get 4 complementary
copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not
including any blue prints. If blue prints are order please be aware that we are not
responsible for the quality of the printed documents.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Z 28 CfV /0 Job Address � /t/ G. / f ,-
Legal Description l5" "1 !t° W ,Z. f / N13.16 ix
36 %
Lessee / Tenant D/2 t . :77 if :AO/24
Owner's Address /13 /t/ /0 Phone 757
Contracting Co. (L.'A) p2 Address A7
Qualifier / cc/
State # Municipal # Compete V _ Ins.Co.
Architect /Engineer
Bonding Company
Mortgagor /7"//3-40-Ac
Signature of owner and /or Condo President Si
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
** * * * * * * * *
FEES: PERMIT RADON C.C.F.
APPROVED: Fire
Zoning
Mechanical Plumbing
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION FA / % / E SC/ PAP / OR ?3 F f d c) S2..)
oJ TAMS 4/ u -e a1cy N — W ' 1) .hPaV - lL)31tr
Square Ft. Estimated Cost(value) toltod—
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 regulatin co struction 'zon' Furthermore, I
authorize the above -named contractor to do the work st
D
a f
(0
Notary as to C
My Commission
/I'3 ` 19 / q/b
Tax Folio •
Master Permit #
of Contractor or
•
Building ^ '. 11I Electrical
ilder
r I AL NOTARY SEAL
v or s9Rlireim-flA!I.der
., ,� COMMISSION CC255237
7 44r
O MY COMMISSION EXP.
OF F4. JAN. 26 1997
**
NOTARY TOTAL DUE 410
Other
Engineering