LOW VOLTAGEDate Job Address J1 S /(/ L✓ / O a- S 1I"-' Tax Folio "/ 3 / G 1 4122 C V2G
Legal Description '1\ (� �-
/:.Lessee / Tenant C 2
.43' a el N�� /1/4.2 Master Permit 0 3 /fS.2._
Owner's : Address g N phone - 2 7
Contracting Co. fts�T � G v r � fl A Address /O,rd_ S. PETyt/2 ( (; * - t o t 2 ,
‘.e_&r ("—
6 L f - 7 7
:PERMIT APPLICATION FOR MIAMI SHORES VILLAGE '
Qualifier wl((tfrvr, l>v 1(n H r — o,.l SS4r~ . - - Phone
OOoO
State 1 Municipal f Competency 1� Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one):. BUILDING
PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION I$LtJ UDL7s-6 �P C Ucr I Sit S7�=W
Square Pt. Estimated Cost(value) 9�
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 meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLIJNBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is
be done in compliance with all applicable laws regulati n con true o �,�•
authorize the above—name • •ntractor to do the work sta d.
Signature of
Date:
owner and
Notary as to 0
My Commission Expires:
** * ' *
Condo President
OF CIA • , z A
ELUSON A SHAPIRO
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC197409 '
„14.412 » IMFSSIQN.EXP. AfR. 29,199,E :;
*
accuratb and that all work will
g. Furthermore, I
.
7 v "•� caner— Builder
e ontract•r o•.�
./ 41 A
Date:
N ary
My Co
*
F , ,
' = ElfittalMiStION # CC 383081
EXPIRES: June 14, 1998
.......... Bonded Thar Notary Public Underwriters
FEES: PERMIT 3e2, '- RADON C.C.F. v -CO NOTARY
APPROVED: Fire Other
Zoning Building Electrical p
Mechanical Plumbing Engineering;
er
TOTAL DUE O ,'"
Bu'' • er
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