ALARMAPPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ; Job Address d ?7 /1/ 1O/ 5', Tax Folio
Legal Description
4g wner / Lessee / Tenant k \kl.L1.( C'1\5 ):3 Master Permit # 3 3
'Owner's Address
Contracting Co.
1 - WN (- \ A 5 Wsz 1 Phone 9 M - $c\c\4
AL,g5 ( Address .5 7 e W /J 077
4
Municipal #
SS#
Competency #
Square Pt. Estimated Cost(value)
Fire
Phone
Qualifier
State #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIG
WORK DESCRI TION
Ins.Co.
__2E1/1
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO D(
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEN:
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. understand that separat
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING a d MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is a•curate and that all work wil
zoning. Furthe
be done in compliance with all applicable laws regulating construct
author the above -n ed contractor to do the work stated.
ignature of:� •-- p ent Signtu
a
Date: d �L��KL�
� Date:
fW is$I � ti Oriti
Notary as q '`4,4f oreklAdtb•PN c iii Notary as • rc , ' pt.
My Commission Ex res: My Commissibra res:
Other
Zoning Building Electrica
LE
Expires
alder
e &MN q b. (je►iMe910i lder
** * * * * * * * * * *
FEES: PERMIT ®' RADON C.C.F. /, NOTARY TOTAL DUE 45 /
* *�
Mechanical Plumbing Engineering