MECHANICALDate 1. .2 Job Address 2 i 2. I" E 101
Legal Description
/ Lessee / Tenant
Owner's Address 212 /V E l O S T
''�Q
A d /� ( Phone /y�
Contracting Co. (2-1 � 1� I' t r l�0 r��0� t "1 S CO , Address fa 80 )( 6b P 13 0 (/I�am, 0.31/6S
Qualifier PAPteelr . CI,/ yJ 't SS# Phone 3Q" 6 8.1' C 39L
State #CAG .2 # OqR gO2 3 Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANIC ROOFING PAVING PENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost(value)
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 applic laws regulating ca>pstru tion and zoning. Furthermore, I
authorize the abov named contracto to do the work stated
Signature of o
Date:
Notary s t
My Commission Expires: s.9.4 .c .
** * * * * * * * * * * * * * * * **
FEES: PERMIT RADON C.C.F. NOTARY TOTAL DUE
APPROVED:
3�.
9.%
Zoning
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
er and /. Condo President
Mechanical
Tax Folio
Master Permit #
resideB.1bert 7. Chryst Signature dfl Con ' actor or Owner- Builder
MY COMMISSION # CC741112 EXPIRES Date:
May 24, 2002
BONDED THRU TROY FAIN INSURANCE, INC
Notary as to Contractor or Owner- Builder
My Commission Expires:
Fire Other
Building Electrical
7 1 - 16 Plumbing Engineering
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami
Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and
regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address
Distance to next nearest building
Bui
in g
MOAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
APPLICATION FOR = UILDING PERMIT
Registered Architect and /or Engineer
.° d
Name and address of licensed contractor �./.1.14_e.. 4 s4yC e Rs3 ,70f._. ..
Location and legal description of lot to be built on:
Lot Block / Subdivision._ l e
Street and Number where work is to be done
State work to be done and purpose of building (by floors)__ y
/h $ / 1 - - - -_l . /i4 . 4., c ef2 � .(.9.��.ts -- -
i` �.�z._1 ,t( CO.a�t �.E9.a.e and for no other purpose.
Remodeling Addition Repairs No. of Stories
Kind of foundation Roof Covering
v
Date..{ ' , 19
No Street
New Building
To be constructed of
Estimated Total cost of improvements $ -- 49' � Amount of Permit $
Zone cubage required Plan Cubage
Size of Building Lot
Maximum live load to be borne by each floor
I hereby sub the plans an. specific ions for s uild' .All notices with reference Wilding ilding and its ns':n may
be sent to ! / / =gip ! .7 0.4"
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement,
and has complied with the provisions thereof, and will require similar c(�mpliance from all contractors or sub- contractors employed by him
in the work to be performed under this permit; and will post or cause be posted for inspection on the site of ,e work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such ubcontractors, on rk be performed Older t
permit, as are licensed by Miami Shores Village.
L e
Remarks (Sig ' � A lsslj� ���% .............
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authrized to administer oaths and take acknowledgments, personally ap-
peared
to me well known,
and who, being by me first duly sworn, upon oath deposes and says that he is the_
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Permit No 1� �- ? Date
Disapproved Dat
(Signed)
Read, Sworn to and Subscribed before me.
Notary Public, State of Florida
My Commission Expires
L ANNING BOARD DATE
Chairman Member
Member Member
Member Member
Council Approved Date Disapproved Date
NOTIE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of 51.00 will be charged when such re inspection is made necessary by improper notice for inspection or faulty
materials and /or workmanship.