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PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /07/ Job Address / l 'f0 © OW /0/ 57. Tax Folio Legal Description Historically Designated: Yes Owner/Lessee / Tenant ( z d9 i2 IL _ Owner's Address / Li 0 0 fl/ Contracting Co. ry 1 d;-• Queer r9w►,/,sz2_ State # Municipal # Ins. Co. Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION P (oz, G ISN ' Lt. '9 Square Ft. WARNING TO OWNI n RESULT IN YOUR PM CONSULT WITH YOU Application is hereby made to obtain a p erinit 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. ignature : o R" r and/•/ ondo President Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT ' ` G, RADON ) t / 57 , Phone Address SS# Phone 2 (ob Competency # Address Address Estimated Cost (value) 1 i $ M ECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, J ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Signature •r on actor or 0 Notary as to Contractor or Owner - Builder My Commission Expires: r C.C.F. / NOTARY Master Permit # No \-- 4 /d t-f ,$ �! - vfoO Date BOND 4. TOTAL DUE APPROVED: ) >(1 Zoning Building Electrical Mechanical Plumbing Engineering