PAVING•
Date / 9 Job Address /7( /6 Tax Folio
Legal Description � a / 5" 4Y
/ Lessee / Tenant /WK , ?/9 Master Permit # 3 73
/ S� Phone ?s/
/74t, 4 //
Owner's Address
Contracting Co.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Qualifier
` ) / 1/
� �� A �2 SS4i � - Phone ��/- 1� s�
State # — Municipal #t
Competency # Ins.Co.
Architect /Engineer
Bonding Company / 41 / Address
Mortgagor Address
Permit Type(circle one): B LDING ELECTRICAL PLUMBING MECHANICAL ROOFING " NCE SIGN
WO DESCRIPTION
Square Ft.
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 constructio ` ;I zoni F hermore, I
authorize the above -named contractor to do the work stated.
Signature o
Data:
Notary as to owner and
My Commission Expires:
FEES: PERMIT 516
APPROVED:
Zoning
nd /or Condo President
e LUCRECOA r,OR'ALE
COMMISSION # t;(. J48051
I EXPIPES Midi 21
• BONDED 'riRU
OF 0 ATLANTIC BONDING CO , INC.
RADON C.C.F.
Address
Address
Date:
NOTARY
Fire Yi Buildin R *
Mechanical Plumbing
/r5I5 & - w // "
Estimated Cost(value)®
Cont actor or I er- Builder
Notary as to Contractor or I - " r -Bui
My Commission , FxRires:
// LUCR CIA COk; ALE.Z
c COMMISSION L,C 348059
lire EXPIPES MAt12' 1998
* * 114-Sr * F. *D r
c\ ATLANTIC " iR CO
* * ,.
TOTAL DUE
Other
Electrical
Engineering
_f
/'RUL b. K/ACV
11620 NE lOp'r Si
Lo-1 Slocl, , PA.S. Sec_g
LOO S+ree
E st) mate c A Co
C ° e to "/i) t 7
` iox
63 14,000, o p
_(2,
60'0,00