PAINT PERMITDate t ' - '7-/9- 0 ° Job Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
/ 2�7
Architect/Engineer
Bonding Company
Mortgagor Address
v - / .s f Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant C'A.r'777� Master Permit # e777 7$
Owner's Address Phone 3 0
Contracting Co. ' Ow Ne +Z Address
Qualifier SS# Phone
State # Municipal # Ins. Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION PA J'-' e 7�/' i /'
Square Ft. Estimated Cost (value)
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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in conrpliasSce with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT RADON
APPROVED:
Signature of owner and/or Condo President Date Signature of Contractor or : uilder
_ O O
Date
6 )'`J1 -2 2--( - OO
as to Contracto r Owner- Builder Date
My Commission Expires:
C.C.F. • o NOTARY S - BOND
TOTAL DUE --C
Zoning Building Electrical
2 -7 7-6,
Mechanical Plumbing Structural Engineer