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BUILDING PERMIT7.' j "' ' A... MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regula- tions of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. i Date-___ ______ __ -- - - - - -t — M X 19 7 . Owners Name and Address ! _ .,A,/ a� " No..,—. Street__!____ 1 '-'`'%--.. Registered Architect and /or Engineer_ _2___i .. Name and address of licensed contractor__' 2" " ` / ,fr--- // 1"' f Location and,legal description of lot to be built on: Lot__ _ � � Block.. " 7 , :. __ —_ Subdivision —_„4—=— --- _ ! •. > Street and Number where work is to be done ° �''= =- __,, State work to be done and purpose of building (by floors) New Building ___________ ___ _ __ Remodeling_ To be constructed of (- 4 ti Kind of foundation_ STATE OF FLORIDA, COUNTY OF DADE. and for no other purpose. Addition___________— _______ Repairs ND. of Stories - Roof Covering____, — Estimated Total cost of improvements $___ _________________________Amount of Permit $_ _sE' Zone cubage required,Z Plan Cubage_ Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under - - permit, as are licensed by Miami Shores Village. �. Remarks (Signed) Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No y � 4 L Date / / +1 7 Read, Sworn to and Subscribed before me. Disapproved _______________________ Date (Signed) Building Inspector y ommission Expires L NNING BOARD Notary Public, State of Florida DATE . � Chairman = —.► Member Member !�1� Member `�� _ � � Member �� �' -- Member Council Approved_ _____ ____ _._ ______Date Disapproved ___ ____.__— ______._,_________.__ __.Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. y/ A lt / • is STATE OF FLORIDA) COUNTY OF DADE )SS e) , i,/ ° 1. File plans and specifications and obtain approval of Village Planning Board and of the Building Inspector. 2. Apply for and secure a permit. 3. Pay the require(' fees, for license and for permit. 4. Execute the work in accordance with the provisions of the Zoning, Building, Plumbing and Electrical Codes of Miami Shores Village. 5. Apply for inspections. 6. File with the Building Inspector certificates that pro- vision has been made to carry the necessary Workman's Compensation, Public Liability and Property Damage Insurance. 7. File with the Building Inspector as the job progresses certificates showing the payment required by the Federal Social Security Act to the State of Florida or the United States of America. 8. Assume the responsibility of not employing other than properly licensed contractors by Miami Shores Village for any part or portion of the work. 9. Not set himself up as a "Contractor ". 10. Execute Builder's Bond. of the Village of Miami Shores, County of Dade and State of Florida, being duly sworn, doth depose and say, that under the provisions of Section B -368, Sub- section (d), of the Building Code of Miami Shores Village he desires to build a / on Lot /7;)/t ,/f e Block of ,,!1,1/�%6. t ..54;‘,7". � 2 • subdivision, that he is the owner of said property, and will be the owner of said that he will do the work personally, and that he will, at such times as are required by the Zoning and Building Director: -- And further this Deponent says not. 1. ,- SUBSCRIBED AND SWORN TO BEFORE ME this A.D., 19 2. t 1. Signature of Applicant 2. Signature of Officer administering oath. A MIAMI SHORES VILLAGE, FLORIDA 5 ! BUILDING DATE Contractor's ELECTRICAL PERMIT N? 5569 PLUMBING 4cen No. k to be perfor ed under this Permit 't,.1 �A _ •Ps 44, 14; n Owner o Building t Architect • Contractor or Builder Legal Description Address of Building Signed: This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are c • •ged with. t autl .rizatio�. A further condition u.• which this permit is granted is the understanding that the contractor or builder named above ass 9• ....1 e res •, .ilit a t ' th kno • . . nan nd regulations pertaining to t the work covered hereby whether shown on the plans or dr y�• r .. io an •. respon- sibility for work done by h agents, servants or employees. By In consideration of the issuance to me of this permit I agree to perform the work c overed • •reunder in compliance with all ordina pertaining thereto and in strict conformity with the plans, drawin • ements or specification submitted to the proper authorities of In accepting this permit I assume res .nsibility for all work . • either myself, my agent, servant or employee. AUTHORITY and regulations mi Shores Village. 15. )1 MIAMI SHORES VILLAGE, FLORIDA DATE / PERMIT N? 5569 to be perfo under this Perini Subdi- vision t o the .. _ or builder named, above to construct the buildittt or to install the equipment or device described in the appli- strkft compliance with all ordinances pertaining and with the understanding that thy ork will be performed in compliance with any a Lions that may have been submitted to and approved by the • • Municipal authorities, This Permit may be revoked is not alone in compliance with such ordinances or if the plans are ed tau , tion. A further condition u . , • which this n t ustleisteoding that the contractor or builder named above •, a of .. and to covered hereby whether shown on the plans or r; . on- *Oak done by agents, servants or employees. ��� g Value of Perm t ) Permit of the rm to me of this permit I agree to psrfo the wa covered der in compliance with all ordi and regulations terbt whh the plans, is or specificati subnutted to the proper authorities of • Shores Village. Pen* I'assame !batty for an work , myself, my agent, servant or employee. AUTHORITY BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. Owner's Name and Address /° ) Registered Architect and /or Engineer Name and address of licensed contractor _. r Location and legal description of lot to be built on: Lot 1_. 1 .`I.L� /„�. �" 7 w ` p .�.�. Block , ! G 1-41",- ,�.. ,. Subdiision. ) 1 -� .. -�- � R8 =3 7 . .___ ...__ _.___. Street and Number where work is to be done /_ l ' 9 C.... ••-- • I - �,� — � - -- ' State work to be done d purpose of building (by floors) ,, naC. 4 - ••• -• 'a °� Q -• -• _.•_� ... C sass and for no other purpose. New Building Remodeling Additior. Repairs loo. of Stories To be constructed of _.'e : -- Kin of foundation Roof Covering....... .._._.-..._ Estimated Total cost of improvements $ 5 -40 ► © Amount of Permit ca. . .-, Zone cubage required plan Cubage Distance to next nearest building. c 0 Size of Building Let '7 th' / X > / / Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building end its construction may be sent to.... .• •.• . ass. -. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of Libor under the 'Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida., Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work su uhl notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, en, work to be p der this permit, as are licensed by Miami Shores Village. /' Remarks._._ ( Signed ).... // 4 STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take ac`snowkdgra- nts, personally ap- peared and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Permit No..__._._ ' V- ! e __.. 9 " ` �'_ head, Sworn to and Subscribed before ma. MIAMI SHORES VILLAGE `f Disapproved (Signed) Building ector ate Date .,. No.. ,` j Notary Public, State of Florida omra:r:sion Expires .____...._ ,197 7 _. Street-2'2 .... '..f.. to me well known, PLANNIN r BOARD DATE Chairman Membcr Member Member Member sass.. _....__._._..- -- •_-.- - -.. Member . ---_ Council Approved Date Disaprrc-v ................... Date NOTE: A charge of $1.00 will be made for making coraec±'ans or charges rc ;s ns,p1 :cation hater approval :las been obtained from the Planning Board. A re inspection fee of $1.00 will be charged when such re- inspection is e? da :1rn.csary by !:mprcper notice far ;nspee:tion or faulty materials and /or workmanship. c r Owner's Name End Address . Name and address of licensed contractor.. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. To be constructed of Kind of foundation Date No. _. 4 e 09.6i? Streeter 9/ $ 7: Registered Architect and /or Engineer _ Location and legal description of lot to be built on: Lot ,l' .. _. _... Block '/ q Subdivision Street and Number where work is to be done r��✓�r . State work to be done and t: 'rposc of building (by floors) % �! • 2,5 5' ;; re /C z and for no other purpose. New Building Remodeling Addition Repairs No. of Stories Roof Covering Estimated Total cost of improvements $ __Amount of Permit $ Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building End its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under he Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub- contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on wok to be performed under this pennit, as are licensed by Miami Shores Village. Remarks (Signed) - -. !' STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application and that he did sign the same, and that all facts Read, Sworn to and Subscribed before me. therein by him stated are true. ; ' // Permit No / Date Disapproved (Signed) a/ Building I pector Notary Public, State of Florida My Commission Expires to me well known, PLANNING BOARD DATE Chairman Member Member Member Member . _ Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and /or workmanship. 4 LL�yx�ST ST Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be compli =d with. whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. ✓Owner's Name and Address Registered Architect and /or Engineer ?/Name and address of licensed contractor eet and Number where work is to be done Mate work to be done and purp STATE OF FLORIDA COUNTY OF DADE. cr i J SS. MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT 1 v 7 Date Q-4 -D Location and legal escription of lot to be built on: Q, Lot Block Subdivision - 7 y� J.� J 1/ 9a2e d / 9 1%1 1%1 2 /77 e of buildin (by, floors), state exterior colors (submit sam les) New Building Remodeling Addition Repairs To be constructed of Kind of foundation U t 6 Aimated Total cost of improvements S "' —� mount of Permit S Date 19 ��yy i� No. /lv� Street Roof Covering .9,7, co Zone cubage required Plan Cubage Distance to next nearest building Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under his permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned ato employ onl sh su}ontrac on work to be performed under this permit, as are licensed by Miami Shores Village. ? II r Remarks (Signed Date Size of Building Lot Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, at he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Read, Sworn to and Subscribed before me. Permit No. Disapproved (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Notary Public, State of Florida and for no other purpose. No of Stories to me well known. Chairman Member Member Member Member Member Council Approved 1 ate Disapproved Date NOTE: A charge of $25.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning 13oard. A re- inspection fee of $25.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials andior workmanship. PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date '1 (I' Job Address . /33 ,4I i. 5/. Tax Folio /1. r Legal Description / 1 c( �� /f q q 7ne .g Master Permit # a g Owner / Lessee / Tenant MR a (R Ai/ ;ee.14 4 it Owner's Address 43 3 /V 1�. J/ J • Phone 7 5 7 - 3 f Contracting Co. 5 w_. F Address Qualifier SS# - - Phone State# Competency# Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL 0110 FENCE SIGN WORK DESCRIPTION Square Ft. h ca lea -e 7e /e,. , s /i �dPVr. cozcc,ze7'e /0 )d 7_0/ 3[a j-r, Estimated Cost -g S no 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. 8. /- Signature of Owner and /or Condo President Signature of Contractor or Owner - Builder Date: Date: ae/7/%4 Ati- V4 :/ Not 'y ark to Owner and /or Condo President Notary as to Contractor or Owner - Builder My Commission Expires: li//i/9 My Commission Expires: * . * . * * * * * * * * * * * * PERMIT FEE: APPROVED: Fire Other Avt-- 'Cla # Zoning Building Electrical fi r Mechanical Plumbing Engineering 1a II II ' r ., • g ' { J. H. MANUCY, INC. LAND SURVEYOR 4694 PALM AVENUE Suhe 203 HIALEAH, FLORIDA 33015 PHONE 821.1281 821 -1220 4 •IMMIX, • ORDER NO. 1917 3 1 HEREBY CERTIFY that the Plan shown hereon represents a S vey made under my direction and is True and "¶ ct. to the best of my knowledge and belief. J. H. M." Reg. Land Surveyor No. 1128 State of Florida SURVEY OF: All of lot 17 and the West z of lot 18, Block 49 of MIAMI SHORES SECTION NO. 2 according to the Plat thereof as recorded in Plat Book 1 at Page 37 of the Public Records of Dade County Florida FOR: MARIAN E. KIRCHER F.B• 241 -47 REV. DATE: NOV. 16,1976 II II g ' 1 11 to ___,, j 1 { J. H. MANUCY, INC. LAND SURVEYOR 4694 PALM AVENUE Suhe 203 HIALEAH, FLORIDA 33015 PHONE 821.1281 821 -1220 4 •IMMIX, • ORDER NO. 1917 3 1 HEREBY CERTIFY that the Plan shown hereon represents a S vey made under my direction and is True and "¶ ct. to the best of my knowledge and belief. J. H. M." Reg. Land Surveyor No. 1128 State of Florida SURVEY OF: All of lot 17 and the West z of lot 18, Block 49 of MIAMI SHORES SECTION NO. 2 according to the Plat thereof as recorded in Plat Book 1 at Page 37 of the Public Records of Dade County Florida FOR: MARIAN E. KIRCHER F.B• 241 -47 REV. DATE: NOV. 16,1976 e ADDRESS'- ;) LEGAL /- ;/ I ' ';'RECORD'GARBAGE TAX PAID BY C ' <- ' 0 YEAR ANNUAL TAX PERIOD USED AMOUNT PAID DATE PAID , i A / - d-- 'Vr i - -/ . . c / RECEIPT NUMBER / .5 13 3 /fr -1 7 ( f / . r m '$/// 7 c . / /94/q / • 4.1- g 1 t h 4 I c ).__ J--€) i /7 5 ,, „ 0 1 e , • ri-S/ I C i s•-.:..3 / ',.ri , / 0 %. :'.7 , - ,- ,.._ e ADDRESS'- ;) LEGAL /- ;/ I ' ';'RECORD'GARBAGE TAX / JOB LOCATION (S OR AVE.) .�G /ZZ. /% ? 7 r. BUILDING PERMIT NO. DRAWINGS x REPAIRS ALTERATION ADDITION OWNER'S NAME GF'.ERALCONTRACTOR NEW CONSTRUCTION L∎ 4 J SUBMITTED TO PLANNING BOARD SUBMITTED TO VILLAGE COUNCIL DATE RESUBMITTED TO PLANNING BOARD 127/ /Y. LOT BLOCK /7 /Z / 4 1 9 ADDRESS 7fDO /1!) /,LE PRESENT ADDRESS & PERMIT FEE S //d . JJ!1 r _ f �J j / ZONE /" °EOUIREMENTS rC C� O C , G` CU. FT. PLAN CUBE /f� /_ CU. FT. SPECIFICATIONS, RESTRICTIONS AND CUBE CHECKED BY: TYPE STORIES ROOF CONSTRUCTION DESCR IPTION DESCRIPTION APPROVED REJECTED REFERRED TO COUNCIL REMARKS LICENSE NO. — SUB2i1VISION / 2 40864 PHONE NO. /y •97 BLILDER'S BOND ¢,y NO REASONS DATE CERTIFICATE OF OCCUPANCY NO. 496 ISSUED 3/ D BYaH TO Mr and Mrs Geo H_MBTtin BUILDING PERMIT AND INSPECTION RECORD -MIAMI SHORES VILLAGE PHONE NO. LICENSE NO. /339 EST. COST S / / /DCiCJ DATE INTERI R CON RUCT10 J .f � ,ecN Zf .�1FNT A YE NE- / o o es - L!/vcD , INSPECTIONS DATE BY RE— INSPECT BY RE- INSPECT BY FOUNDATION FEE �;� $ SEPTIC TANK REAMS &LINTELS./ jr/)97 .- 'S a ] /x- /47 MIS $ r FRAMING $ GAS $ S INSPECTIONS DATE FINAL 3/12/48 JDH RE— INSPECT BY ROUGHING " " DAATTE � r y ;? '",(� CLEAN -UP GAS ,SEWER PERMIT NO. 33 DATE 1 'i4/' FEE S / P NEW BLDG. X I ALTERATION 1 ADDITION REPAIRS SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ SEPTIC TANK `` i n[.Qy�/`33 $ SEWER $ SOLAR HEATER $ GAS $ S INSPECTIONS DATE Y RE- INSPECT BY RE— INSPECT BY ROUGHING " " DAATTE � r y ;? '",(� ``�� i GAS ,SEWER EHS H. W. HEATER CONN SEPTIC TANK 0 /' 7 ��tt fa) i tars RANGE CONN. ,SOLAR HEATER FIXTURES 3/15/ S__E C tfg to Investors Syndicat FIXTURES & FINAL CONTRACTOR lis or e11U PHONE 7 -2278 FEES1Q.`� REPAIRS PERMIT NO. 5872 DATE 11/17/4.7 NEW BLDG. ALTERATION f ADDITION SPECIAL PERMITS PERMIT NO. DATE FEE TEMPORARY SERVICE $ H. W. HEATER CON . $ RANGE CONN. $ MOTORS $ FIX1i1RES $ $ INSPECTIONS DATE BY RE— INSPECT BY RE— INSPECT BY TEMP. SERVICE ROUGHING 12/i/41 EHS H. W. HEATER CONN RANGE CONN. FIXTURES & FINAL 214/48 EWS BUILDING INSPECTIONS UMBING PERMITS & INSPECTIONS A TO POWER CO. FOR SERVICE DATE 2/5/4 ELECTRICAL PERMITS & INSPECTIONS BY EWS PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date3 4 7— 6 Job Address'' E ( CC�( S Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant*- *ire //4/0 (/ C t Owner's Address S; '/?, ` . O q/5 (o , S Nd KCS Contracting Co. .(' 156t( LT" (C(4 Y fl r � C. Address Qualifier SS# Phone State # Municipal # Competency # Ins. Co. Address Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle ofie): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING WORK DESCRIPTION _ 1 APPROVED: Zoning Mechanical FEES: PERMIT Square Ft. Estimated Cost (value) /960 R c. 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 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. Signature of owner and/or Condo President Date AO,/ ill 1 1 1 Notary as to Owner and/or Con. • Prem. ent Date My Commission Expir ,0paY P4/ OFFICIAL NOTARY S O �� BARBARA ANN r'Ut:A . t lY ? . COMMISSION NU ;E ;I ` c CC3601 S1 "7, Y COMMISSION EV- o sin rtz r c RADON C.C.F. Building Signature of Contractor or Owner- Builder , CY/v2 akbi f ez), 5V7/9 Notary as to Contractor or Owner -Bu Date My Commission E Master Permit #� Phone NOTARY Electrical PAVING FENCE SIGN O2Y Pei OFFICIAL «.0 i AI? S'= O, _ - <i BARBARA ANN FUC _ ' � ` ` r O COMM'.: NUM Rti 3o-`; Y. ul 1 ' ,'• < CC:360101 7 l ;4 e 1 .' - OM !S ',Cr :: i. F ORF1 - Y j' ° 1 TOTAL DUE Date Plumbing Engineering