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PAINTDate WORK DESCRIPTION PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 8? /0 ( 5 - 1 — Tax Folio No� Legal Description Historically Designated: Yes Owner/Lessee / Tenant c ) bit /A' 144 S Master Permit # t/3 Owner's Address `t /U 6 /nom S Phone :?0S 7 5 / Contracting Co. CD L J j, J Address /./ 1E /O, 5t Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one) BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Pre 65 u < •e_ cP-<,,4,7 HOUSE ©h kl Square Ft. Estimated Cost (value) / CO 0 / a-O 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 in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. g coni.vtizeize,euw. , 3 /' / ?7 ure of owner and/or Condo President Ddte Notary as to Owner and/or Condo President Date My Commission Expires: FEES: PERMIT RADON C.C.F. c c 3i / ? gnature of Contractor or Owner- Builder D ate otary as to Contracto Owner - Builder Date My Commissio I) a OFFICIAL NOTARY SEAL & r YygM: ,. Q CC797277 7 .. e OF F1 O re MY p COOM C MISSION 02 ES NOTARY BOND APPROVED: TOTAL DUE \1 Zoning Building 'Pi; Electrical Mechanical Plumbing Structural Engineer