MECHANICALDate
Legal Description
Owner / Lessee / Tenant
Owner's Address
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address -3,-5 95
3 (15 A'' If..., S / Phone 2.57/
Contracting Co. U a GG' 2 Oi �ry G Address --?/ /tom'
31.02,
3 9 - .26
Qualifier qq
State if 409 # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle
WORK DESCRIPTION
7
Square Ft.
one): BUILDING ELECTRICAL PLUMBING CMECHANICA ROOFING
PAVING FENCE SIGN
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 =bove -named contractor
Signature o owner and /or Condo President
Date: 3 /S /5
Notary as to Owner = n zi'G9oAfteTtt#Kid fttseAL
SCOTT W DAVIS
- \ * COMMISSION NUMBER
a CC255237
ci s MY Ct P:lft.4ION EXP.
** * * * `c dPF F\ * ' ' * ' % `3.19t?7
My Commission Expi
APPROVED:
-\/47 ' 4'//' Master Permit # 3.5;92
Estimated Cost(value)
to do the work stated.
FEES: PERMIT 1 TC RADON C.C.F. 'f!"
Tax Folio
Notary as to
My Comnissio
*
Fire
Building
Plumbing
Signature of Contractor or Owner- Builder
Date: j /4/cti -
t pr moo '. ,'• AA
es„, COMMISSION NUMBER
a CC255237
�4 q� MY COPMISSION EXP.
aF FN. JAiy. 2i 19 7
**
NOTARY -x TOTAL DUE ✓ eo7Or
Other
Electrical
Engineering