ALARMPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 1- 1 4 15 /99 Job Address/K.7,44/(g / iu NAt, Tax Folio /' Q/Q U(/'7 -•0
q Ste. 1 )22.1.:(444,u hfiz40.4
Legal Description
Owner / Lessee / Tenant
Owner's Address //2,
Contracting Co.
Qualifier
Address
Master Permit 1P.- fO/
Phone - 4 / 4 4 W
SS4 - - Phone q S «' �� D
State eaail unicipal # Competency # Ins.Co. i(de'' aZ 9)10
Architect /Engineer - Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION caVAilla-e-eJ -.AA/
Square Ft. Estimated Cost(value) oC
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 re uir d for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OAR S AFFIDAVIT: I ce rrtify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President
Date: Date:
ignature of Cont ctor or Owner- Builder
ai(/l AAA -&-
Notary as to Contractor or Owner- Builder
Notary as to Owner and /or Condo President
My Commission Expires: My Commission Expires:
NOTARY PUBLIC STATE OF FLORIDA
MY COMMISSION EXP. MAR. 10994
BONDED THRU GENERAL INS. UND.
** * * * * * * * * * * * * * * * **
FEES: PERMIT , 6"P RADON C.C.F. 1'46 NOTARY TOTAL DUE i (t
APPROVED: Fire Other
Zoning Building Electrical
Mechanical Plumbing Engineering
uc,
Date:
City of:
OWNER'S AFFIDAVIT
_192 Zr certify that I am the
ownervof the proper y described as:
Address: Z/26 , .
__s ue
Legal Description: ��i
iL__Ua _ �
Folio Number: 01 LO 9 0 0 17
I authorize Kertz Security Systems, Inc. II as my agent to
obtain a building permit for the following work:
STATE OF FLORIDA
COUNTY OF DADE
Ow S gna re
/ 06 /07 ,O
Driver's License Number
Witness Signet "re
X63 - Zz-q -L/8 - o 7
Driver's License Number
Before me personally appeared who
by me being duly sworn upon oath says that the statements set forth
above are true and correct. Subscribed and sworn to before me this
day of 1 9___ .
NOTARY PUBLIC FOR COUNTY, STATE OF