41426PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date
lob Address /9 71- % �, 'ta cFolio %/ -3a Dom'-- O 2 -- USED - -O
Legal DeEnPtiOn
/Tenant
OvandsAddress 1W...6 E Q'7 044t. P53 — 3844,
Historically Designated: Yes No
Master Permit #
40q,11;
Coating Co.
QuarfaHr
State #FFVW (L/!/ L/ Municipal # ° Competency #
Architect/Engineer
Bonding Company s. Address
SS# Q44; - /3 '
Mortgalior
Permit Type (circle one): BUILD
WORK DESCRIPTION
Address
EELLECTRICAL PLUMBING MECHANICAL ROOFING PAVING CE SIGN
/-
ScpwrePt. Estimated Cost (value) �j 0 619
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).
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 cornpliance with all applicable
laws regulating construction and zoning. Furtherrnore, I authorize the above -named contractor to do the work stated.
7
Signature downer and/or Condo President
ALI
otary as to Owner and/or Condo President Date
My Commission 'r-
�p'pY PVC OFFICIAL NOTARY SEAL
‹i SAMNA GI HIRSCH
* COMMISSION NUMBER
▪ CC348646
PAY COMMISSION SSP
1 18
FEES: PERMIT g ,'P
APPROVED:
RADON
AZAZ
Signature of Contractor :'Owner- Builder'
otary as to Con
My Commission
C.C.F. ' t ® NOTARY
4[1
Date
uilder
•p &A OFFICIAL NOTARY SEAL
SARm4* ar HIRSCH
* COMMISSION NUMBER
CC348646
• MY COMMISSION SSP
MA. 1 1 0
f:6
Date
TOTAL CUP 36r: '6°