PAINTDate
Legal Description` ' /4,'2- ,BL /G /.f S Sc. e' /.x/
Lessee / Tenant /. 7A/4Z D /1L /i4/GtiF.4Z_ Master Permit # .3 -3a/7
Owner's Address /22 /VE-- /0/ ST' Phone ,3O5 /2.58 - OAS
Contracting Co. GLt//!/g[ 0/2')F�2 Address <'
Qualifier SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION fI.j/!/T es7c`T£'A2 /OA? ef /c /70245 L..
P a ss v2 CL_044& A /r25
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.
Signature of owner and or Condo President Signature of Contractor or Owner- Builder
Da . Ve,cArcg. /•G,?l (r' Date:
in-4-u . Pc
4 /2Oh ICa #4. r//
Print type or stamp name of Notary Public
Notary as to Owner and /or Condo PresidentPersonally known ealkitrazinye d i•ftb Contractor or Owner- Builder
My Commission Expires: NOTARY PUBLIC STATE OF FLO�IDI!' and nttrnber of 443, p gilss Expires:
MY COMMISSION EXPIRES 5/0994
** * * * Bonded thru - Adams * � D cake an oath, or
D OT talc an oath.
PEES: PERMIT lati,-.1"). RADON C.C.F.
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
2 Job Address /ZZ /VE /0/57 Tax Folio /1 3i o /3 sed /O 7
Zoning Building
Mechanical Plumbing
Fire Other
NOTARY i TOTAL DUE 1 VU
(101 Electrical
Engineering