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MECHANICALPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address /9O'gl'R 9Q I ! Legal Description * * PEE APPROVED: and/or Con Signature of owng� / resident Dat paY P(ie OFFICIAL NOTARY SEAL O f- ZENAIDA LEON 0 CO*AMISSIOII NUMBER .I .r a CC392419 :�g N MY COMMISSION ,� o JULY 131 1 Zonin P Mechanical Owner / Lessee / Tenant Owner's Address lam A)& `7 q a' sun gitim1.� 6b w Phone 75S Contracting Co r"1v i / Q to NE e' Address cm 9V' Std 71/q,I LW) • // /Q�/ Qualifier I960O ofp7,0 A Qe SS# - - Phone C3 •96' (/_4 (o . State Italie 39/9 Municipal # Competency # Ins.Co. I Q Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle on : BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN � WORK DESCRIPTION / / � / to- B 0/2g • /U 4' cc) Square Pt. Estimated Cost(value) R0250.0!) 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 MEC ICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information be done in compliance with all applicable laws regulating cons autho 'ze the above -named contractor to do the work state l Notary as to Owner My Commission Expires: and /or Condo President * Notary as to Contractor or Owner-8uilder on xp My Commissi Eires: � PU OFFICIAL NOTARY SEAL 0 (i ZENAIDA LEON O * Q C MMISSI NUMB * * * v * t t .011: < CC392419 e t* MY COMMISS EXP. C.C.F. � NOTARY Fire Other Building Electrical Plumbing_ Tax Folio Master Permit o>` 3e0 3 a is urate ction a OF F. J that all work will oning. Furthermore, I actor or Owner- Builder ** 8 Engineering • Name and address of licensed contractor MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with. whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of the work. ��Q Date Nor/ 2/ Rd' I9 Owner's Name and Address Q�at�7I- No. I20 Street NE / Registered Architect and /or Engineer " "/A Location and /0 description of lot to be built on: yr/� Ott Lot • O Block i Subdivision 1 CW 6/ " T `� N O v - Street and Number where work is to be done / ?.o9 99 Z ( r /o State work to be done and `' nd purpose of building (by floors), state exterior colors (submit samples) " ' - ' `i T ©` C4�/ CaLD lfl -1 4-1C S�' , to /1q A- / 4'1 c-t-- _ A7C A F- 4 CON46(102 ,4A10 i vae - /vim AM. nr471 geE SE 7L- q.4-re and for no other purpose. New Building Remodeling Addition Repairs No. of Stories To be constructed of Kind of foundation Roof Covering Estimated Total cost of improvements 8 2 , /00. O Amount of Permit $ f . 5 1 6 Zone cubage required Plan Cubage Distance to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all plans and specifications for said building. All notices with reference to the building and its construction may be sent to The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligatons as an employer of Labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to e.•ploy only such subcontractors. on work to be performed under this permit. as are licensed by Miami Shores Village. /G 77 f' 4V,�%4V1 ��.� �, Remarks ) IA' _ CA-Cs 0 33 (Signed) L STATE OF FLORIDA 1 COUNTY OF DADE. ss. Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known. and who, being by me first duly sworn. upon oath deposes and says that he is the of the above described construction. . he has carefully read the foregoing application, and that he did sign the same. and that all facts therein by him stated are true. Permit No. Date / 1 Read. Sworn to and Subscribed before me. Disapproved \ ( Date Notary Public State of Florida (Signed) Building Inspector My Commission Expires PLANNING BOARD DATE Chairman Member Member Member Member Member Council Approved late Disapproved Date NOTE: A charge of 825.00 will be made for making corrections or changes to this application after approval has been obtained from the Planning Board. A re- inspection fee of 825.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty materials and workmanship. To Whom It May Concern: rotary Public, State of Florida at Large My Commission Expires May 22, 1990 BONDED THRU FLORIDA NOTARY SERVICES Super awe o44r ea#ditioni#g Te /rigeratian Tliaiizte#aitce, O 20402 N.E. 15TH COURT MIAMI, FLORIDA 33179 654 -7661 989 -0630 November 21, 1988 I Jay Humash, License in the State of Florida as an air conditioning contractor Class A, License #CACO33555 authorize Mr. Alex Taranu to re- gister and apply for permits in the State of Florida. Job: Address: Claybourne Spencer 1209 N.E. 99 Street Miami Shores, Fl. 33138