38629PERMIT APPLICATION FOR MIAMI SHORES S VI LL A
G VIII
J o b A d d r e s s 7, /' 9 Tax Folio
Legal Description
Owners /Tenant 69/444144.) kJ
Historically Designated: Ye$
Master Permit #
Phone
Owner's Address 47; kie 9i3
Contracting Co. ®74 6 dZ //e CO mil?
Qualifier ® PZ)
State # � 6314-7
Architect/Engineer
Bonding Company
Mortgagor
Municipal #
No
Address (6) r 91 &J ‘4° 1-4,v6e71,rt ,q .
SS# Roe - ‘5' 670 Mr phone
Competency #
Address
Address
Permit Type (circle one): BUILDING ELECTRI li AL PLUMBIN
WORK DESCRIPTION /9 e v® LJ 4410 ectaeore
Address
Ins. Co.
7 -7523
MECHANICAL
P Y2AJ 6
C OFING PAVING FENCE SIGN
piv es"") Oec 6447
Square Ft.
Estimated Cost (value)
9 crla c'
WARNING TO OWNER: YOU MUST RECORi1 A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING ° TWICE FOR IMPR EMENTS TO YOUR PROPERTY (IF OU INTEND TO OBTAIN FINANCING,
';V
CONSULT WITH YOUR LENDER OR AN ATT *ItNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do Work and installation as indicated above, an
certify that all work will be performed to meet the standards of all laws regulating construction •
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANI
on the attached 'addendum (if applicable). I
this jurisdiction. I understand that separate
AL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing', information is accurate and that all work Will be done in co pliance with all applicable
laws regulating construction and zoning. Furthermore, I authorize the above -named contrac to do the work stated.
,
Signa
e of owner and/or Condo Presiden
•
otary as to Owner and/
My
1..:,
MT P.91`'' ORIG3 �L NOTARY SEAL
Se, SANDRA MONTIEL
• F i7' S, * COMMISSION NUMGER
� I rA CC401261
4- MY COM ISSION .EXP.
cap Fre A 4 Os
D
FEES: PERMIT 4' 1. RADON
APPROVED:
Zoning o Building
Mechanical //
Signature of Contract
r Owner - Builder
Notary as to Contractor or Owner- Builder
SAND
f
a \; C :Ott!
Date
/A! e
Date
NOTARY SEAL
A 109 MONTIEL
.s II9 sSION NIA <a GER
p4 ®1261
ISSICN .EXP. 1? 10PE
C.C.F. r S ° NOTARY St
Plumbing
Electrical
Engineering
TOTAL DUE