ALARMPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
b . D \ , Job Address
Description -act` ( )\�\ Q - \ # / Lessee / Tenant V kc.( ` -ur-R �l� \ \\\ Master Permit /�
1 4
Owner's Address \'"\ t1 `� \ b \c�. \\� ►�z�`��\� , S ` Fhone `3 � �-�,c�\
• Contractin: Co. . , ■ i IlN� Address \\\\ � �� ►�`d �`LV �
OA Qualifier %'•c \�� SS# Phon� k0V� US V\
Date
Legal
Owner
WORK DESCRIPTION
OWNER'S
be done
autho
gnature
Date:
State #tVMDV - Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address '-
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Square Ft. Estimated Cost(value) k y y ith
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.
AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
in compliance with all applicable laws regulating const
the above -named contractor to do the work state
MONICA N.i Z
MY COMMISSION # CC 384169
'� 1 ; •� WIRES: AO i 13,199✓3
;1; J. th R Md 11i u Ne :'W:o Und3RwtitO *
Notary as "' President
My Commission Expires:
Zoning
\
4,\\
r
President
�� ��Date:
�� �/
Notary
My Commi
Tax Folio
•n and zoning. Furthermore, I
d.
- O P
Si :mr _ - - - - Builder
MY COMMISSION # CC 364169
EXPIRES: April 13,1998
Bonded Thru Notary Public Underwriters
s- on Expires:
** * * * * * * * * *
,e21 FEES: PERMIT RADON C.C.P.
APPROVED: Fire Other
Building Electrica
Mechanical Plumbing_
NOTARY
1 >` pay cow
6 €. - C/tcc
to Contractor or Owner- Builder
TOTAL DUE 7 r,
Engineering