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MECHANICAL
o PERMIT APPLICATION FOR MIAMI SHORES VILLAGE D a t e v l (Z / J o b A d d r e s s (20 1 N E 1 01 S T . Tax Folio 1 1 - 3 2 O S- 0 2 5- U c) O Legal Description? 13 1 4 2 - L S area rc S-C L C?T 8 Less t4 S k 8 7 Owner/Lessee / Tenant Ma Q 1 CO, 1 m D u Master Permit # Owner's Address 120 t E 1 0 ( �T Contracting Co. DOn' S CDC) ( rl Ur * En\ Signature of own- ( d/or Condo President Notary as to Owner and/or Condo President My Commission Expires: OFFI NOTARY SEAL JAYNE A TURPIN NOTARY PUBLIC STATE OF FLORIDA my COMMISS ION NO. CC73 763 I 8 -3 / - 9 ' 8 Date g //a199 Date Qualifier (12 obe r4- L w 9 t— rY Permit Type (circle one): BUILDING ELECTRICAL PLUMBING WORK DESCRIPTION rep e?t ce Historically Designated: Designated: Yes No Ss# Phones GZS C( ( state # CACo ©85 33 Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address ECHANIC ROOFING PAVING FENCE SIGN Square Ft. Estimated Cost (value) 2c0( ) 56 °% . FEES: PERMIT RADON C.C.F. air APPROVED: Zoning Building Mechanical Phone s -- 7 S L - 02E' Address fJ333 N L J AU e., f 2 5.0 - fi - or G© —dust fTh 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 constructi and zoning. Furthermore, I authorize the above -named contractor too the work stated. Signature of Contractor or"Owner -B -....m.,,,,G.r eir 0 q T„ Notary as to Contractor or Owner - Builder My Commission Expires: OTARYSEA JAYNE A TURPIN NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC739765 MY COMMISSION EXP. MAY 24,200" NOTARY Electrical 1 -/S 3 Li 3 / Date 8 /r9 /gI Date BOND TOTAL DUE 97, ,LO Plumbing Engineering