1189 NE 102 St (13)Date 1 0
Job Address /7 8`4 // L/ 9 Z . SI" Tax Folio 1 1 � 2o. i l 01 001
M , s, ' c- e Lo-r i o 4 - n.( M. some-• b
1 Description
Owner / Lessee / Tenant "ti-/9A_ Master Permit 41' 30/,�
Owner's Address / (0 l/ U7Z e /4(d�I V fJ Phone r 7 7 o si/�
Contracting Co. ( ( b ti4 �' L l d_ go • Address / 2-5) /V 6
Qualifier f L&f, - I1 L &Z_- SS# - - Phon(SJ 6 , 52 -66 , 440
State 4 46 Municipal # 0oq�p44c) #
Architect /Engineer Address
Bonding Company
Mortgagor
Permit Type(circle one): BUILDING ELECTTRIICAL OF
PLUMBING 'MECHANIC ROOFING PAVING FENCE SIGN
WORK DESCRIPTION -- /-15-7 1 -4//47L/
Square Ft. Estimated Cost(value) .
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO D
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 complia e with all applicable laws regulating construction and zoning. Furthermore, I
authorize th• a.. • • d cont actor to do the work stated.
Signature of
Date: Notary
Public
Notary as to
My Commissi
** * *
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
far C • • resident
STATE OF FLT`
My Comm ExP8/1/9
.g.QNDE
Zonin
Mechanical
f or Condo P esident
* * *
Address
Address
Signatu
Date:
ig 771n . er-Builder
Notary ST ATE O qy Cornrr�
B O N DED
Notary .trac •r ., er- Builder
My Co ci4
es.
* * * * * * **
FEES: PERMIT $ RADON C.C.F. 1' NOTARY TOTAL DUE * d
Fire Other
Building Electrical
Plumbing_ Engineering
Carrier
Air Conditioning
• Ov�son or
Car' er Corporator
Carrier
e
Carrier Parkway
Syracuse. New York 13221
Commercial Air Conditioning
RESIDENTIAL AIR CONDITIONING CO.
20250 H.E. 15 COURT
NORTH MIAMI BEACH, FLA. 33179
0 Carrier Corporation — 1961
Prepared for i& 4 Scar FR eh) CC-1
Address 1/89 /it /49.? sT
_-IM' A 57
Estimator ki 751 • 00 /
Salesman £ • q ' 41(03 4
Job No.
Date
E-53 (7-77)
(905 -041)