PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 9/1/000) Job Address i2 2 C /W /6/ Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant , f O �G� 6c `u„ Gt Master Permit # 7c
Owner's Address /22 it/e'._ 444
7 t ( 57-- Contracting Co. W wry /- . 6 c� AA
Qualifier 7
State # " Municipal #
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION P2P..).-)u r d G( 9>/ ti/ — ‘/h
Square Ft. 2
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 infonnation 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.
0A4 a rAe/,7,
e of owner and/or Condo President
Notary as to C
My Commissi
FEES: PERMIT
er and/or Condo : - 'dent
MI El. ' WASKEWYCZ
.. " > >,ir ;,V n CC 721000
1 .'0' Nell 10, 2002
, ''t'' i,ry Pubiic Underwriters
ate
RADON C.C.F.
APPROVED: TOTAL DUE
Zoning Building Electrical
�g �8
Mechanical Plumbing Structural Engineer
SS# / Phone
Competency # 0 / (// 37 Ins. Co. &G 4 "�
Estimated Cost (value) ?mod
Ph
g as-) - 7c - y 78
Address /v76 Ar /3° S.
/
as o Contractor or • er -Bui P,, • � . '� . � Date
y Commission Expires: GLAD' J VIDE
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR.1 CO2
NOTARY
BOND
«. - '
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ( S' q 6 Job Address / ? 2 /VLs / U/ Sc S/- Tax Folio
Legal Description 4e r 7 r 4 R °f i - TT Historically Designated: Yes No X
/36ctf< /8S 4-44/ 4 //-� 2 -e sec 96 G
/O/
Owner/Lessee / Tenant Ja y� 2 � 3 /`fO /-Z.. V$vt / as. Master Permit # "/ 7
Owner's Address / 2 ZS iV /0/5 hi/i3 S z E 5 Phone 7 ry - 7 f 6/
3623 l� u.., 1." e9.c4 Lel e d.� � .
Address fL 32.5 3
SS# - / Phone e6o, 9'.Z -6 .
Municipal CIO 7 /D/ Competency # Ins. Co.
Contracting Co. e(,, S/mi Pa-t x, /
Qualifier
/ (J
State #
Architect/Engineer
Bonding Company
Mortgagor .13144e4r
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION '4 z JOk PA 7/ er
10)1_1- alines z /�i��'3 / T12ti11i coLo>z /S'37 / /32tuc -btiz( 96 7
Square Ft. Estimated Cost (value) _2 C7/7)
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.
-v
Signature of owner and/or Condo President
Notary as t Owner and/or Cofo President D e
My Commission Expir.......— - -
,� GABY
P MY COMMISSION # CC 404794
EXPIRES: December 13, 1998
Bonded 'Mu Notary Public Underwriters
APPROVED:
Zoning
Mechanical
SIT—RADON
PERMIT '-O. S — RADON
Date
Da
Building
• "-tress
Signature of Contractor or Owner- Builder
Date
Notary as to Contractor or Owner- Builder
My Commission Expires:
C.C.F. / SD NOTARY
' -
,`p.(ZY PL6 OFFICIAL NOTARY SEAL.
0 ,..., SCOTT W DAVIS
2 (.7 '
* i %. COMMISSION NUMBER
a Ill' ' ' CC255237
' c is , ''" MY COMMISSION EXP.
OF OP JAN. 26 1997
Electrical
Plumbing Engineering