MECHANICALPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) Fv
DateP` '' % Job Address /2 C Tax Folio
Legal Description
:r °/ Lessee / Tenant
Owner's Address
.ma
Contracting Co. k , // �� =�;
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGi
WORK DESCRIPTION C «:"- ?, e .�
L PE-Z,
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Square Ft. Estimated Cost(value)
OWNER'S AFFIDAVIT: I certify that all the foregoing information
be done in compliance with all applicable laws regulating con
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President
Date:
DONALD BELLOWS
4°, COMMISSION It CC 516594
Notary a
My Commie
D T ando - President
mai
BONDING CO., INC.
** * * * * * *
APPROVED:
* * *
Master Permit #
Phone
Address i /;j , G
Phone 9'7 `(
/ 3 °3 - ..9 -
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WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENL
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUF
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. I understand that separat
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
accrate and that all work wil.
L on and zoniig. Furthermore,
Sigliature of C.oatiactor or Owner- Builder
Date:
•
'mum n BF, OM
Notary as4t..Titpefeet68***Caler,Sdilder
My Commis$i'•j L�xpi9ES DEC 06, 1899
' BONDED THAI)
4 0F0. ATLANTIC BONDING CO., INC.
* * * * * * **
V / /41-
FEES: PERMIT / RADON C.C.F. C . C . F . J � NOTARY TOTAL DUE
Fire Other
Zoning Building
Mechanics 1 Plumbing Engineering
Electrical
• p `
PERMIT NO.
STATE OF FLORIDA:
COUNTY OF DADE:
3. Owner(s) name and address:
I ry 1 fl#L Va %.•%.1111111111...111 LAL-.1111111-01 1
�L.
TAX FOLIO NO.
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property. and in accordance with
Chapter 713, Florida Statutes. the following information is provided in this Notice of Commencement.
1. Legal description of property and street ddress: / t? ) ) �T � ( 5i1
2. Description of improvement:
d
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address: , 6
D (3J (7J /
COUNTY OF ®
5. Surery:(Payment bond required by owner from contrac�q�y LORIDA; b ® ate °4 0 °
n raoC BC! g3QUf ?Ii C11"D* do
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon wh n ;lotil:es or other documeTifs may be served as providE
by Section 713.13(1)(a)7., Florida Statutes.
Name and address:
8. In addition to himself.,Owner designates the following persons) 1 :' r9.:, ?i"e a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration d.: ;te s 1 year from the date of recording unless a
different date is specified)
Notary Public
Print Notary's Na
. My Commission Expires.4
c_1
; CC 516594
EG- 8871 — ' – •'
EIONOED TH�
'DINTS-y _
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Signature of O. r /� g 1;10/L �
Print Owners Name t'
® .
Sworn to and subscribed before me this f l day of 4g.11.___!_, 1 g .
97R 162484 1997 APR 15 10:18
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Prepared bye ) i2
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Address: ^'^ A A
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