MECHANICALPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 6--/7- 8) Job Address J 902, "rcA.S
Tax Folio
Legal Description
Owner/Lessee / Tenant / � ,/ 0 N o S
Owner's Address / Y-2- A/ �
Contracting Co. Ce56,/i i-/ G
Qualifier lN>ot-> /Z
State # CA (0 Z6
Architect/Engineer
Bonding Company
Notary as to Owner and/or Condo President
My Commission Expires:
gc a
FEES: PERMIT (3 ,1C RADON
e
APPROVED: N (u 1 7)
r176-77 a,JS iAp- C_
/9 l
Municipal #
Historically Designated: Yes No
Master Permit # 7 6
Phone 3 C>5 Z 2 s 0 S
SS# / 3 c�1� Z -y57
� e �
Address
Competency # Ins. Co. Dom L /-c-°G
Address
Address
Mortgagor Address
WORK DESCRIPTION (12. 7/e 4 L
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING(MECHANICALL OOFING PAVING FENCE SIGN
Date
Zoning Building
U 6
Square Ft. Estimated Cost (value) .�4Tz ea-
ty &91-/ALe
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 worlystated.
Signature of owner and/or Condo President Date Signature of Contracto
C.C.F. C il i t A i NOTARY
Electrical
8-620 1/6tt
�v — /y - 00
Notary to Con tza ctor • •' ",� =, � . • Y S
My Commission Expir = • : GLADYS j VILLAR
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC71.4103
MY COMMISSION EXP. MAR. 1,2002
TOTAL DUE 149 -
=
BOND
Date
Mechanical 4-67 ((• ) Plumbing Structural Engineer