PAVERSAPPROVED: Fire
Date 7 c 9 92 Job Address �° , � /U �lJ / 6 7 SJ Tax Folio i 2 -O - v5
Legal Description ',- , 45�o2.ts , / ,,, c4 Z v i <j 3 cG // / /�7 0
/ Lessee / Tenant /( S�l
' " / '2c � g 41
% Master Permit .
Owner's Address ...4' 0e &44.9 2,..4.1; 4d "76
Contracting Co..?0e, Co. LS ( TALL- ( AC f .
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
QualifierSAL.1/4 rckt � , AN41 SS#
Phone k l s // f 5 �
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION P41/a - ,2S
Square Ft. Estimated Cost ( value )1 CV
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 onstruction and zoning. Furthermore, I
authorize the above -named contractor to do the work state
Signature of owner and /or Condo President Signature of Contractor or Owner- Builder
Date: Date: 4:2-/
as to Contractor or Owner- Builder
TOTAL DUE 1 455 - 0
Other
Electrical
Mechanical Plumbing Engineering
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