MC-12-524451'3t,Lit. --ALItscit4
BUIL ING
T APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. MCA —
Master Permit No.
RECEIVED
MAR 2 8 2012
Permit Type: Mechanical
Owner's Name (Fee Simple Titleholder)
Owner's Address /C:).Z 11)6-
City State
Tenant/Lessee Name
"P/
zr--1
Zip
g
Phone #
E-MAIL:
Job Address (where the work is being done) /0,2 /V6- ./1 572,re, • /-
City Miami Shores Villa e County Miami-Dade
FOLIO / PARCEL # /0/ -- 3 e:
Is Building Historically Designated YES NO ,><-
Zip
Contractor's Company Name ALL YEAR COOLING & HEATING phone # 954-566-4644
6
Contractor's Address 6781 W. SUNRISE BLVD
City PLANTATION
Qualifier Name GRETA B. SMITH
State Certificate or Registiation No. CAC058160
E-MAIL: Permits@arair.com
Architect/Engineer's Name (if applicable) " Phone #
iY
zip 33313
Certificate of Compete
Value of Work For this Permit $
Type of Work: pAddition DArtelatibn
Describe Work: REPLACE CENTRAL
Square / Linear Footage Of Work:
New
Q,1
1"1----tepair/Replace
Total Fee Now Due $
El Demolition
S
*************************************** *******************************************
Submittal Fee $ Permit Fee $ I 3 111. CCF $
Notary $
Training/Education Fee $
Scanning $ Radon $
DPBR $
CO/CC
Technology Fee $
Zoning $
and - - - -Code Enforc-ement-$77_—_-:-:-_ - -Double Fee $ - - - - =
Structural Review. $
RERAGeD
1049
See Reverse side
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit ust be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, T [{ an'CpNDTTIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is 1 work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMEl t , - 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be .proved and a reinspects ee will be charged.
The foregoing instrument was acknowledged before me this C
day of �% ,2O ,by , _
€ate
day of
who is personally known to me or who has produced 0,L, who
As identification and who did take an oath.
a a All a _• .a a. a a a a.
NOTARY P IC�a��Yp�,,, Notary MICHELLE CHARLEBOIS
:�i, .1% Nota Public - State of Florida
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Sign
Print:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
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Contractor
as acknowledged before me thiOrtt
NOT
Sign:
Print:
e or who has produced
as identification and who did take an oath.
a ai. aaa as a a a
a
XS�;IC: MICHELLE CHARLEBOIS
oo Notary Public - State of Florida
(� iwQ�i� •: My Comm p es Feb 1 115
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mail it i✓llhi%l� ifill it r Sr
My Commission Expires: 1 •-1 iJ
Plans Examiner
Engineer
Zoning