MECHANICAL PERMITDate 2.- l l- 9g Job Address
Legal Description Historically Designated: Yes
Owner/Lessee / Tenant DONALD /C L I +J G'.I C R Master Permit #
Owner's Address 12 2 N E 101 S T. Phone 75R- 0 8 S
Contracting Co. FLOW - r ci-f .4C. CA2P,
Qualifier M42co PE72Ez.- VEc -4s -
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
122 Ng 101 5T.
S t a t e # CA C. 0 2 of 3 7 1 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN G( MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION C4.1446 5 m-WT •EKISTfnfG COnJO /NS/n/G UNIT An10 fnjsrALL "JEW
L1C,NTwEICA-IT P2EFAS - oNe.2 -rE SLAB . <NE C,cJ. e ro 4 s 2 - t4.00)
Square Ft. Estimated Cost (value) 200 U • 00
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
laws regulating construction and zoning. Furthermore, I authorize the above -named co
- fct1,52- I25 - t4,6 -3 -
`i
Signature 6f • er an
or Cond
OU
FEES: PERMIt.' ",{� / RADON
esident Date
a1. I L�� 2 -
'rotary as to Owne and/or Condo President Date
My Co is¢} F jkRPEREZ- VEIASCO , ,
ia. ( i, COMMISSION # CC 640538'
N IR Q EXPIRES APR 20;2001 I r
7 /41 \,` BONDED THRU
aF,W ATLANTIC BONDING CO., INC.
Tax Folio
Address ? 0 2 3 S W 3 TE1ZR •
SS# 264- SoS/
Signature of Contra
11 work will be done in compliance with all applicable
tor to do the work stated.
or or Owner - Builder
Notary as to Contractor or Owner- Builder
My Commission Expires:
C.C.F. ! NOTARY TOTAL DUE
2 - !l-
Date
Date
APPROVED:
Zoning Building Electrical
l ��
Mechanical 1r Plumbing Engineering