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PAINTPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1 7 Z `1`LJob Address J7 7Y.6- Tax Folio Legal Description Owner / Lessee / 1 /,'S 6 4% / ;'4 1, Cc O Master Permit �Fff�o7i Owner's Address Phone Contracting Co. Address Qualifier f /I14'} /4j/ SS# - - Phone �fC State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILD(.? ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. / 750 My Commission Expires: APPROVED: Signature of owner and /or Condo President Date: az F .*- 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 stat Estimated Cost(value) /©U( 0 Notary as to Owner and /or Condo President Print type or stamp E: me o ota Poo Personally known rig r( PCt5?! $. Type ail.] number of 1.D. poduced: • y i ZoningBuildinR J_ g re o tractor or Owner- Builder Dates: / �1���9 1 JOSEPHINE CHURCH ‘Notary Public, Me Si IIMM aim- Bui lder ** * * * * * * * DiDktake an (Ark or °* * * * * * ** ��}} � - DID NOT take an oath. FEES: PERMIT J `, Q RADON C.C.F. , 5 �-- U NOTARY ,1 O 0 TOTAL DUE glee Fire Other Electrical Mechanical Plumbing_ Engineering BUILDING 111 MIAMI SHORES VILLAGE, FLORIDA „i Date_ 1947 ELECTRICAL ❑ PLUMBING ❑ PERMIT Np 8437 ROOJING ❑ ry ❑ Work to be performed under this Permit 1R Ow o f + / �► L cke * t . I4l '� � Buildin ner —__ j — Architect or Builder kir) 1 Contractor �- ,, v r► Legal Lot II Description II BI Address of Building a F r This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the pl are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assu the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether hown on the plus or drawin •r in the statements or specifications and that he assumes respon sibility for work done by his agents, s v� or /tmployeei ... . Signed• CONTRACTOR or B t LDER f /J, Subdi- vision Sq Ft. c,,r-� Value of $ 2 7 Contractor's ,j ie License No. e d icor+.4. Z. Amount of 4 2 II Permit $ NSr)LieTselec BY In consideration of the issuance to me of this permit I agree t erform the work covered hereunde compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings t ements or specifications submitted to t • oper authorities of Miami Shores Village. In accepting this permit I assume resp.nsibi for all work don y either, myself, my agent, servant or employee. BY AUTHORITY 16 r 3-