1996 MECHANICALD
•
Legal Description 1listorically Designated: Yes
r � Tenant (/)(t'(,'40 11
Owner's Address c r / j Phone 7 l0 9c7-3
Contracting Co. . 1 �/J a) Address 0 r / /5—e7/66
SS # ,"
State # . �� � � Municipal # Competency # Ins. Co. e///
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
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Job Address 9 72L 9 / / 3 f 7 9
No
Architect/Engineer
Bonding Company Address
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ROOFING PAVING FENCE SIGN
WORK DESCRIPTION P I C e t CJ Q Ce At �/ I
5 TOM cevAILA ( $40d#7 'Mot, o JFk4 eN600
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS Te 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 install ition as indicated above, and on the attached addendum (if applicable). I
certify that all work will be performed to meet the standards of all la ws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS. ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAV : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating co ction and zoning. Furth- .•• - I authorize the above -named contractor to do the work stated.
APPROVED:
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W Pm Date
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H ES: PERMIT � • RADON
Address
Address
Estimated Cost (value) 2400
Master Permit #
Notary as to Contractor
My Commission Expire
C.C.F. I . NOTARY
390zer,
Signature of Contractor or Own - Builder Dat
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Date
TOTAL DUE b
Building Electrical
Plumbing Engineering
Residential Air Conditioning Co.
20250 NE 15 Court
N.M.E3., FL 33179
65a - 60 1 -10 -.ADE
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