PAINTDate Q "A.(Q F Job Address Iv 0 I S Tax Folio
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant O ►" `_ l (?‘` 1V Master Permit #
Owner's Address )? H N . 10 t S l
Contracting Co. t) Lk.) /\)
PH - 5
Qualifier one
State # Municipal # ns. Co.
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost (value) tg `7 co. c99
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 pemrit 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 Date
Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder
My Commission Expires:
FEES: PERMIT
RADON
APPROVED:
Zoning Building
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
P-s N- - • \A-t TT E
C.C.F. NOTARY BOND
My Commission Expires:
FD \A.l S"60-c-fk,p -- 37-- L/7 D— O
o HILJ 7-2•
Electrical
Phone3 c 5 — ! s 1— 9 ; ( )
Date
Plumbing Structural Engineer