MECHANICAL PERMITDate
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 3 3 dE 5 ( S f Tax Folio / /-- c3 •�O '-- v / - 0/ Z U
Legal Description Z / 7 e co 7 . /6) X11'
Owner/Lessee / Tenant / /f / / k > / 3 / /el Master Permit # 3 c ? 7 ` i1/45�
Owner's Address 4/8` /v ' P. 9J S' '4 "1, Phone l f r i/ - 2? / r
Contracting Co. C� Address ,,37693/ � /17' 1 ' ' ; ,V//. �'/
Qualifier 12 C- 6.-17 ss# . Phone 9 ?'74
State # (?) 4, Municipal # Competency # Ins. Cc.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION L ��'"! ��,�G6'd` /.
Historically Designated: Yes No
Square Ft. Estimated Cost (value) �f 44, 727: -a
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 co ctor too the work stated.
Signature of owner and/or Condo President Date
ar v* PG COMMISSION # CC 516594
ai■ EXPIRES DEC 06. 1999
.
Notar9 ��.- • er andANDEORnikisident
My Commission Thfite39 BONDING CO.. INC.
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FEES: PERMIT 7 d RADON
APPROVED:
Date
Signat . e of C o • r or Own - Builder
o PG t CO MSSI CC 516594
Gi EXPIRES DEC 06, 1999
,n Ab.•,`
y,'n• + act�,�� �1 �
My Commission Expires: I NC .
C.C.F. NOTARY
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TOTAL DUE 7 5-
Zoning 1 Building Electrical
Mechanical Plumbing Engineering
`f
Date
Date
4/2 9 c-
IvV 1 IUt U1 WIVIIVIL'IVI.:L IVILIV 1
PERMIT NO. TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF DADE: 96R209471 1996 MAY 15 09:39
•
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property an street address:
2. Description of improvement:
CMG -/T6
3. Owner(s) name and address: NC r K ,T h' 1 ` l / 2 H em
a33 n1. 4 41 r)
Interest in property:
Name and address of fee simple titleholder:
C.� W
4. Contractor's name and address: � _
, /U • '. /6 �-7� �� - /y (�_ , 33/6
5. Surety:(Payment bond required by owner from contractor, it any)
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provide
by Section 713.13(1)(a)7.. Florida Statutes.
Name and address:
8. In addition to himself „Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 ; ear from the date of recording unless a
different date is specified)
Signature or Owner �
Print Owners Name lv !z ( i/1 -1 f £i
Sworn to and subscribed before me this i Li day of )1 19 � �•
Print Notary's Name
BONGED THRU
My Commission Expires: ''O P ttrtrlto "°''""N° rn arr --
STATE OF FLORIDA, COUNTY OF DADE
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Prepared by: 4L . d0
Address: 9o3r �v /T) s'�..
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