PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Dated G 6 - 93 Job _Add ress '{ /< yE / / •'''(
Legal Description4' t c / 0 VV c� ck?
Owner / Lessee / Tenant .57 J .S UL /'/./9/)-
Owner's Address 47 /11t / O l 6 '7
Contracting Co. ( 8M7 / v NNW Address / /70I(,,[1• t?I5 e-4N4G. R.D
Qualifier / 1 O8 7 /v &D/V197 SS4t Phone g?,3
State It /4)09' Municipal # Competency # /frg Ins .Co . fro Qt i(! P1VM
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION f1,76S5L)JQE l� >9A' .44/0 f:9/Air ExTERIc 4-GS'/ 14
cm/14r eo z -
Square Ft. Estimated Cost(value)
Signat
Date:
N ary ¢s to Owner an
M Commission Expires.
** *
APPROVED:
Zonin
Condo President
* ` "e.* JOSEPHINE CHURCH
' :Notary Public, Stotc of Hondo
doM 'ab�aasisEiA. RO 30,
P; Wo. CC197545
•
Tax Folio 11,301,4i/
9/ A‘15:e0
tar ' as to Co
y Commission E
Master Permit 1k��� ° /
Phone
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 n // compliance with a ae "licable laws regulating construction and zoning. Furthermore, I
authority ►Ehe above-name d/p " = to do the work stated.
f rl
Signatur of ontractor or Owner- Builder
Date://:
, ifs p- -- -- ......_ _......_.
= t 4'b� QTY �FI(idlon 146 �. ^o a °: No. CC197545
FEES: PERMIT �'_7 l/ RADON C.C.F. / 4 ' NOTARY S` w TOTAL DUE "I J°
**
Other
Electrical
Mechanical Plumbing Engineering
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