MECHANICAL PERMITSPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 6 /4 -' Job Address
' 9 9 ✓
Legal Description "7I /oZ
Owner / Lessee / Tenant YIC JO W4$or4
Owner's Address - \A I NI. E . 9 & � � O gr. Phone 75q - 2 1 "17
Contracting Co. 4(4 A IKUJIVpj11Os4f (i i 4c • Address 7oSt S -t. Mii ,
Qualifier Ik M.4) LLO' 0 C4Plj0(4
ss# - Phone S92-5
�{ UABIL11
State # GbI(p (28Municipal # Competency # Ins.Co OM o4. 14 VJ, fomp
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL �I-( "
L PLUMBING (MECHANICAL, ROOFING PAVING FENCE SIGN
WORK DESCRIPTION ge p L G�1 4Er 1 0 AIC 5 To NI U / 10 K. f46A - 1 - In Sag-
Square Ft. Estimated Cost(value) 1240
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 •- •mrliance ith all applicable laws regulating construction and zoning. Furthermore, I
authoriz , • •ve x �� �qn, BS JOSEPHINE CHURCH ,tated.
,vi , / c••- V6 •. c
:Notary Public, State of Honda
30. 1996
** * *
APPROVED:
nt type or stamp name of Notary Public
N ta as to Owner and/'6iSO
y Commission Expires: Type an. number
DID rake an oath, or
DID NOT take an oath.
* * * *
Tax Folio // �a a 65 005 ob
Ma La- iIa wi
Master Permit #.- -
0.
Signature of ,Contactor or Owner- Builder
�.�. Date: �j/ �o}
1��!�+ W LL' L ►- . 5 1 P.SbN ?ATM, Pv
otar -s - 1•Z' tractor or Owner Builder
My omission EWAN UM STATE OF FLORIDA
MY COMMISSION EXP SEPT 0.1992
BONDED THRU GENERAL INS. UM).
* * * * * * * * **
FEES: PERMIT V- RADON C.C.F. . NOTARY -J ToO TOTAL DUE r I % 7.6
Fire Other
Zoning Building Y M 2 Electrical
Meeh cal ^ � Plumbing Engineering
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
,q ^^ 9 9J S � // .<9, 65 as Date 8���i � 2 Job Address Tax Folio
Legal Description.6�7,JoZ
Owner / Lessee / Tenant Vic JOW4S.0rI
Owner's Address - \ C k 1 � . C.. q& RO �� "t•
Contracting Co. 4( A WCOpij t1t °t4' (i. /dr • Address
Qualifier ILkMM LLO i D Ci&J of 1 Phone S92-5780
�� �• L.faBl� + ?
State ��Cb1(0�8Municipal # Competency # Ins.Co .lhogotS -E loot
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL, ROOFING PAVING SIGN
WORK DESCRIPTION I�CfLGG-1461 1 / 0� A r.4 UIi i'
/ 5 to
1-( "/ 10 K. - IDSa-
Square Ft. Estimated Cost(value) /2400.
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 - •mrliance ith all applicable laws regulating construction and zoni g. Furthermore, I
authoriz , - • ve � cQn e o • • Mated.
��
. �+ e : JOSEPHINE CHURCH
:Notary Public, State of Floods
s /�'7`� ►`�.i. �. - 30.1996
Sign . .
Da
type or stamp name of Notary Public
as to Owner and/'6Fie h :'b
y Commission Expires: TyPc''r'' number
** *
DID take an oath, or
DID NOT take an oath.
* * * * * *
FEES: PERMIT Vag
RADON C.C.F. . NOTARY -670 0 TOTAL DUE 7Z 7 I.5" ..
APPROVED:
Zoning
Master Permit 4�J-3
Signature of ontractor or Owner- Builder
Date: 1 0
My
* * *
Fire
Phone /5' - 2 1 17
7ScxS W 5��= s-�• 1414,44 i .
.5 1,5.sPa '41, Pvw-ic
tractor or Owner Builder
ommi s s i on EIiVA%BUWC STATE OF FLORIDA
MY COMMISSION EXP ,SEPT 0.1992
BONDED THR J GENERAL INS. UND.
**
Other
Building Y - Electrical
Plumbing Engineering