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290 NE 101 St (7)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date' /11i:k Job Address O210 4/E70/ S / Tax Folio I/ 3U 9j I3 ii 5W / i # / Ji 7 46 1 3/1/ Legal Description t Owner / Lessee / Tenant ®x / 40/1/ Owner's Address 2 ?0 / V /0 / £ / Phone ©S 7$L V 15' Contracting Co. 4 F&//)2;/1/ ,J_ "' /k Address i �• / t Qualifier �48 <ki:C SS# �" 6 ��!)� /) State # Municipal # Competency #(��9[9 Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBIN MECHANICAL 'OOFING PAVING FENCE SIGN WORK DESCRIPTION - 3 -1-4) CCU 3 8 c V n ' Jb-n / 6 . dO Square Ft. Estimated Cost(value)% 2/ O 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 aut : i.: the above a e• = ract do the work stated. I till Signature o �•�'�i�•- 'o� Signatu' Con racto or „ i Owner - Builder Date: - � Date: ivir'a �. �'` om _ L��✓� a ru Notary J f9 n . • Qci=c0 My Commission Exp QED ** * * * * * * * * FEES: PERMIT / w / c RADON C.C.F. APPROVED: Fire Other Zoning / ? Building Electrical Mechanical ) ;� ''�' ) ? J Plumbing_ Engineering Master Permit # � Notary as o Cont ac or or Owner- Builder My Commission Expires: * * * * * * * ** NOTARY TOTAL DUE ; Carrie( Airc onditioning e o , v,YOr� 0' Ca^ er Corporal or Cancer Parkway Syracuse New York 13221 Commercial Air Conditioning RESIDENTIAL AIR CONDITIONING CO. 20250 N.E. 15 COURT NORTH MIAMI BEACH, FLA. 33179 o Carrier Corporation — 1961 1 Prepared for S(.) ' v 01 772 9 0 NE /0/ ST / _iTh A Sho s 737- his°72 757• it58.? Estimator Salesman Job No Date ACC s : e*. 03 vi ONFo3 • ',15-041)