MECHANICALDate
Legal Description p t f p / / 1 8 , / / /ML
Owner Lessee / Tenant„ 1 (� 4PPf/C,/ Permit 1fr 5ff9
Owner's Address f Phone CJ �p ° C-7q' 55
Contracting Co. ? fiS1DE/V Jlth- /Ile(4Nt); ika dress �U C 7 - /frnia .33/ j
Qualifier "ear /i & /$/ f2 SS# - - Phone 303 .5 - 60 $
State #frf COAO(iunicipal #
Architect /Engineer
Bonding Company
Mortgagor
Permit Type(circle one): BUILDING ELECTRICAL PJUMBING
WORK DESCRIPTION 4 - Ton
1T M o4g TIAiV ®4- 2 g° k LJ S U 7�'
e sLeti Estimated Cost(value)c..�.a39O
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, S_:GNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the forego =ng information is accurate and that all work will
be done in comp ' -°c- ith all applicable laws regulating construction and zoning. Furthermore, I
authorize t above -nam•d contractor to do the work stated.
er and
�Etv'
�! ST
Condo President
Signature of o
Date:
Notary as to Owner an
My Commission Expires:
** * * * * * * * * * * * * * * * **
FEES: PERMIT (r)/ --- RADON C.C.F. 02
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address / 6 A/E 9 ST Tax Folio /i 3,706 a ,.fD C�
Competenc
y
Address
Address
Address
Fire
Zoning r Building 7/" RC'1 Z
Mechanical; l' j Plumbing_
Ins.Co.
MECHANICAL ROOFING PAVING FENCE SIGN
7&_.P
Ito
Signature o Contractor or - r
Date: Ivira L bunch
TE F O FLORIDA
omm Exp$ /1/9 . II
Notary as to C. L Ar'lja i l r
y' ommission Expires:
NOTARY TOTAL DUE 641
Other
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Engineering
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