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53873PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 3- 71. -/3 Job Address 7 Z- A) E 9 Cg ST Tax Folio %` t21v6 I/7 /7I©, Legal Description/4411 k `i2/ 6 ,e%;, Lessee / Tenant Owner's Address /3 ici-nfrit) "l0 /g7.22 � Contracting Co. ,/t-e) 6 7 /N< , Qualifier 1 cN4Cc- 014A-P4/r ss# - / Phone 1oc- �9i,r- State ,1 #CFe °61-0-94 Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL ,'LUMBIN MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION "Lob d? / /A) F/ .D iN 44c/c of it'''s ' . Square Ft. 2 b d 1J Estimated Cost(value) // d v 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 jurisdictjon. 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 au ize the ab•e -na — tractor to do the work stated. Sigriat e of /owner and /or Condo President Date: Sfeelf3 Not 'ry = ' to Owner a My ommission Expire ** * * * Signature of Contractor or Owner-Builder Date: Notary as to Contractor or Owner- Builder My Commission ExpitC§: ,e� �:; wFats J a * * * * * * * * * * * ** FEES: PERMIT / Oki RADON C.C.F. C'02 NOTARY 5-0 TOTAL DUE J/s Pe Fire z Other Buildin Electrical Mechanical Plumbin < Engineering APPROVED: Zoning