ALARMPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Tax Folio //5 '() ) "
Date 2 I�j 'RoJob Address 0 J (0 ( ST
—
Legal Description Loi— 7 // / /
Owner/Lessee / Tenant 41 0112 -1L C
Owner's Address
Contracting Co.
Qualifier I Vi Cft\frt5 &2(
State # EQ(.CJC� c�5 Municipal #
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL ' LUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION }'(id4 -f2-- ' 5 Ti \ — V o L TlA6 c W 1 1 1t. t tc 5 5
1
Square Ft. 0 0 0
My Co
►N I" Iol '3T
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 regulate :rstructi• and zoning. Furth = , •' orize the above -nam col actor to do the work stated.
and/or ' on• o Prey t Date
Notary as to Owner and/or Condo President Date
APPROVED:
Zoning
Mechanical
AR ' E A. UTCHI ' SON
MY COMMISSION # CC 648710
EXPIRES: May 19, 2001
"•' Bonded Thru Notary Public Underwriters
FEES: PERMIT,3e•.5 ®RADON
Historically Designated: Yes No x'
Master Permit #
Address ° r> 6,14n 6 3'5 ec:.—
ss# hone -777( )
Competency # Ins. Co.
Address
Address
Estimated Cost (value)
Signature Vontractor or Owner- Builder
EXPIRES: May 19, 2001
F U F °.` Bonded Thru Notary Public Underwriters
Notary as to Contractor or
My Co
Phone 0 — S (p " Fro&b
Lo--)
Date
Date
C.C.F. ' 60 NOTARY TOTAL DUE
Building
Electrical
Plumbing Engineering