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46153
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address ('7 ii-Q ©(g S T Tax Folio Legal Description Historically Designated: Yes No O w n e r / L e s s e e / T e n a n t L I if !WS S A M ( ) n M A-N-1 Master Permit # 1-167 , f3 Owner's Address L7 a 1 g' g Crrir Phone 30s-- %S % 7 50 Contracting Co. a) JO) 1:4 A) C /J( ... Address -3GS- 754 9 0.2_, Qualifier 'h7)11-1■110 -1)144,61-7 ss# Phone 30 &--7S'1 state # 0 a - s 7 16) 0 Municipal # ./° Competency # ✓ Ins. Co. Architect/Engineer Address Bonding Company Mortgagor Address Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANIC WORK DESCRIPTION _ICEt, /-(,tom U,Q *,w5 1 11/./7,g �4) r' Of i PAVING FENCE SIGN nmA C) ore6P Square Ft. Estimated Cost (value)I/376—C22 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 F.LF,CTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNERS 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 zonin s. Furthermore, I authorize the above -named contractor to do the work stated. Signature o' owner and/or Condo President Date lam''1 doov Notary as to Owner and/or My Commission Expires: fustimPun Mod AWN oil MKS 0003 '01 agwaoep :S381c1X3 MIS x! # DIOSSIINWpC AW 1.1 , '•= Btl030il 3Nf�3P Nth108311 FEES: PERMIT RADON APPROVED: Zoning Building Mechanical C.C.F. Signature of Contractor or Owner - Builder Date 0,0 a /I 70o Notary as to Contractor or Owner- : , i der UAW— My Commission Expires: cr" P£i BARBARA ANN FUGAZZt 2 i R 0 coMMISI ION NUMBER I .. a CC723488 9�• tt• MY COMMISSION EXPIRES FOF FVO MdB. 29,fl02, NOTARY BOND Electrical TOTAL DUE Plumbing Structural Engineer