FENCE' 4 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date pj - / 4 -96 Job Address ) / 6 0 4 .6 . 100 57 Tax Folio
1-01 5 61K i'l a Revl5ed Plato ( -rYdcM-
Legal Description 17 A I 'i 4'85 04'C 1 11 b it !l b 13,06c n7 k Historically Designated: Yes No
Sec. ) P.S.�t3 P 6 7 11 X78
Owner/Lessee /Tenant N OQMA ►1 KfZg1l I A aJ Master Permit # 403 / '
Owner's Address ) /20 n) • 6 . I Q /O 5T
Contracting Co. Cd rGi n a I +- e n c e J • Address
Qualifier & e•t a 4 • ,_(_ C- N (} S SS# - Phone 7 7 8 / 6 S
State # Municipal # Competency # 12 (o 90 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING ENCj SIGN
WORK DESCRIPTION L ' i rt i�n. C • L ce T 2- L. r •
Square Ft. Estimated Cost (value) V 7
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 Condon= President
•814 /96
Owner and /r dent Date
My onunisitiri; zpr 1l, ;1;" '�
e `"`,, My Comm Er ;;. / .
l � ) B53nd:Ni By S " / ..
• t r. i7
CCS3: /
/. • 1 1 Mc 1. D.
. ja Pe>SC.^ ^.alt � K::own
FEES: PERMIT Z(0 RADON
APPROVED:
Zoning
Mechanical
Buildin
Date
C.C.F.
Phone 7Y ) • 1 7
Sign: ture •f Contractor o weer- Builder..
to Contractor or Owner - Builder .17; My ommission Ex0re�s: L ' a 1 r
n 'r 3.4)o 1 1 u M ' a _,
� • a:c w °.uOD 1 1
V ���2,iy��ilu �C�dC
of
i S -0 NOTARY
r 1
Date
TOTAL DUE •i/0r
' 7 V Electrical
Plumbing Engineering