MECHANICALSignature of owner an
Date:
Notary as
My Commi
FEES: PERMIT
APPROVED:
Zonin
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PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date ( ( 6 / Job Address /cJ 7 NC 9'd f
Legal Description � - v � S 9 4 " 4Grk 23 0,f9 f'-/i9 fP7/7
/ Lessee / Tenant 1 1i M U LT U i r Master Permit # (Sr S
Owner's Address J 3 ) Phone Z � / S �� �74� 7`
Contracting Co. \/AL t m0 A /C,
Qualifier a r C. VAS- -t SS# Phone S'S -'$u1 .
State #'Clc:cr1/44Rs3 Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING( MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION a C, 3.. a � z c� Tcr•� �1�
�v c� c� nv= i � k.c�.� ,z_Jr S
Square Ft. Estimated Cost(value) 'd1 y.(...‹)
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.
xpire
Mechanical
EMMA V (MEDEROS
MY COMMISSAR / CC 260679
EXPIRES: Fpbruaryr 18,19J7
Bonded Thru NopUy, Poblc (k,de#Rttars
Tax Folio
Address /SA CO. l k
y Commiss
or Owner- Builder
EMMA V. MEDEROS
i r Mr tOMMISSION # CC 280879
EXPIRES: February 18, 1997
Bonded Thru Notary Public Underwriters
lder
** * * * * —- ! * * * .;-_•. �...� . **
RADON C.C.F. )/ NOTARY
TOTAL DUE /5% 25
Fire Other
Building Electrical
Plumbing Engineering
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. H. U. 2 MODEL 4 RRE414,505 NU s A I
5 H.W. HEATING
C U . 1 MODEL f! RALR 036 J42
3.0
TON (CEEB 11.25)
C.U. 2 MODEL 4 RALR 024 JA2
2.0 TONS (SEER 11.15) .
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DIPiIPNG ROOM
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13.5( W. '319Th 51
HIALEAH FL
556 404'1
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BEDROOM 1
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BEDROOM 3
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1337 W. 40t11 SI
HIALEAII FL.
556 -4047
CACO35489