SHUTTERSPERMIT APPLICATION FOR' MIAMI SHORES VILLAGE
Date ci • 4 Job Address coVcT K7.) (,U1 ' 4 Tax Folio 1 -L04: C; 4 1 :J 6,.r )-C.".
Legal Description C&I 13 (C)) �+'
(per / Lessee / Tenant ti'3Cr 1 C - p-P(rt '.r Master Permit # 47,7
Otiner 's Address 1413 6 1.01 1 i• 1, 1 m-4 .' i_13 Phone - - 1 C J �Li ' — I C I , V: 3
Contracting Co. (Y\ icL : Ru,i` -4- ' l f Address ( Lb,-3 5 ICI 7 ): � .
H -' l'...) 11 ^
Qualifier 0.1',U C t✓ /1 CI SS# Phone
State # 1P- Municipal # #0() )(, J Competency it l‘
Architect /Engineer 1'-
Bonding Company 6-.4
Mortgagor Address
Permit Type(circle one): BUILDING PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION T ( 1 ` . 1 1 0 4 ' 'No - .\ L e .r --
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.
OWNER'S AFFIDAVIT: I certify that all the foregoing informatio s a c rate and that all work will
be done in compliance with a applicable laws regulating con ing. Furthermore, I
authorize the abov- .med oritractor to do the work sated.
nat re of owner a or Condo President
Date:
otary as to Owner and /or C dent'
My Commission Expires: ii, ,Cratesb ign fp
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APPROVED: Fire
Zoning Buildi
Address
Address
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ture of Contractor or Owner- Builder
t�
Notary as to ry r34 Sr Owner - Builder
. My Commission Expi es:
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FEES: PERMIT O RADON C.C.P. g° NOTARY TOTAL DUE ' 2;5
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Other
Electrical
Mechanical Plumbing Engineering