MECHANICAL PERMIT(
State # Municipal #
** * * *
FEES: PERMIT / Jea
APPROVED:
Zonin
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 0/ Address !/' 4 , 4 /x/ Tax Polio
Legal Description
Owner / Lessee / Tenant
Owner's Address
Contractin / � Co.
Qualifie v F44'it v ; */N7/4 ss# - /
Mechanical
*
.c1-0 42; "/C L- 1-7/ (
4)
WOR DESCRIPTION 14 %
/1 *
� a . �� /2
Square Ft. Estimated Cost(value)
Signature of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
• /
KIWI/
Phone
7 my ,� V 'N V �
Phone � ad7
Competency # Ins .Co. '/ / , -2,S''
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Nz
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MBAGHIWPC ROOFING PAVING , FENCE SIGN
Address
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 above -named contractor to do the work state
il tr
r
Signature of Con
Date:
.o.
Notary as to
My Commissions
* * * * * * * * * * * **
RADON C.C.F. NOTARY TOTAL DUE 1 Si)
Fire Other
Building
Plumbing
Master Permit
3rPV
#c5)(*(Fi
actor or Owner- Builder
u
• ° .`:a4 "OFFICIAL SEAL"
r� s, Ben • w •
or M ,s}r 0 � • 4.io EXpires r 9
( I : o ' mmission #CC 443432
Electrical
Engineering