1997 PAINT 91 NE 91 STPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date (d /6/b9 Address ?/ Iv 1. � ] I SL Tax Folio
Legal Description Historically Designated: Yes No
-}-- y
ssee / Tenant � °� � ► � �} Master Permit # / - � c,- d 5 I
Owner's Address C J L ') S.-tn.-9-QT
Contracting Co. S
Qualifier
State #
Architect/Engineer
Bonding Company Address
Mortgagor fry 1 . - - Address Ft , L
Permit Type (circle one): BUILDING ELECT ' CAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
FEES: PERMIT
Municipal #
WORK DESCRIPTION
Notary as to Owner and/or Condo President Date
My Commission Expires:
Address
Phone 5 - o
SS# Phone
Competency # Ins. Co.
Address
0-„_12 vi\ Loct_o--es:
Square Ft. Estimated Cost (value)
6
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 regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
,% GL� Imo^ /DA V?
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C 4 /
S i of owner and/or Condo President Date Sign a of Contractor or Owner - Builder Date
RADON C.C.F.
fcJi-7f q y
Electrical
_ CP ecW2
Notary as to Contractor or Owner - Builder Date
My Commission Expires:
O � p S&Y P( OFFICIAL NOTARY SEAL.
/i SANDRA M MONTIEL
_ * COMMISSION NUMBER
. l CCb01291
7,.. � � MY COMMISSION .EXP.
' OF P AUG. 17 1999
NOTARY " .9 BOND
APPROVED:
Zoning Building
Mechanical Plumbing Engineering
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