PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date Job Address ( 1 q () , 5 T Tax Folio
Legal Description Historically Designated: Yes
Master Permit # 7 6o {,
Owner/Lessee / Tenan t 14J I LL, 411. / 4 ' -'
Owner's Address Phone 7 5 76
Contracting Co)( N •e y- Address
Qualifier //�� SS# Phone
State # Municipal # hs. Co.
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle on : : ILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Signature of owner and/or Condo President
Notary as to Owner and/or Condo President Date No : , as to Co
My Commission Expires: My Commissio
FEES: PERMIT
RADON
Adaress
WORK DESCRIPTIOl ' a,e;r4 - - - /Y1 (71-t h 171 i C51e11447
Square Ft. Estimated Cost (value)
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.
/P V/// -
Date Signa Contractor or er- uilde at
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t Pt3BL IC SPATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR 1,2002
C.C.F. / NOTARY
BOND
No
Date
TOTAL DUE
APPROVED:
Zoning Building 14 1 1 k / Q Electrical
Mechanical Plumbing Structural Engineer