41327PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 3)/ /77 Job Address 1 Z l5 %L( F 7 Sr. Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant M r S . C j r m 7rf Master Permit # '1/ 362 7
/a i .E. 97V Sr Phone 7. ) 7 9-33
Contracting Co. 1 �4w) L) E E.g. Moe4', A2.9
Owner's Address
Qualifier 1914 A.a LL) E E E
Address 114°3I Al . 1'7 7 9''
ss# /( (Phone - 1770
State # Municipal # Competency # / 1119 g Ins. Co. au . Li 003T-e, &
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANIC AI/RO 19TT PAVING FENCE SIGN
WORK DESCRIPTION
dIV rrLE r taf
Square Ft.
3 .1 41.
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 re ; -ting construction and zoning. Furthermore, I authorize the above -named contractor to do the' work stated.
S, +
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Estimated Cost (value)
O tune of owner and/or Condo President
Date
otary as to Owner and/or Condo President
My qi° al l?e F AL IIC,T nY SZAL
s ip f c S d A 6',i K 7T'1E6
SMP.
HO��•:i. 17ad072
FEES: PERMIT
APPROVED:
Zoning Buildings °���
Mechanical Plumbing
RADON
x'/' 7
C.C.F.
tra._ 6711 19-7
Signature of Contractor or Owner- Builder Date
?Pi2;r11...,C1) 5" / /97
Notary as to ��
Contractor or Owner- Builder Date
My pa•« - )8 xpiics -
\p,PY PO OFFICIAL NOTAriV s:.
C4iFAISSI®PJ EILZIMEN
NOTARY
Electrical
BOND
TOTAL DUE
Engineering