MC-13-570i y
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: MECHANICAL
OWNER: Name (Fee Simple
A
��20i3
Permit No. btz I L/ U /0
Master Permit No. t t -- 1-7S & 0(
City: In e'er 6�-c5 State: Zip: f
Tenant&zsss°ee Name: Phone#: -�
Email: '1-c �) k K' - a 1
JOB ADDRESS: _���r �V-rja fl�''�
City: Miami Shores County: Miami Dade
Folio/Parcel #.-
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: N Ey P SS Phone#:
Address: _ (, (Jyhf WNW -refaiL-
City: w –state: F Zip:
Qualifier Name: /" �`% V C Pl►orie #:��i S r Z2
State Certification or Registration #:
Contact Phone #: A slid
- � �6 � � � � � 2 Ui Email Address: �A
DESIGNER: Architect%Engineet: Phone#:
.Value of Work for this Permit.' $ o
Square/Linear Footage af;wark ": _
Type of Work: DAddress X41teration ONew ORepairMeplace
Description of Work:,:
Submittal Fee $ Permit Fee $ _ V ° CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ '
G -ea-'
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
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 must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT 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 approved and a reinspection fee will be charged.
Signature v Signature
Owner or Agent Contractor
The foregoing instrument was acki wledg ed before me this t�
day of ' 09.0 by
o is personally known tom or who has produced
As idena'ca"tweyd o i
NOTARY PUBLIC:
Print: ,tea 10-11 l kC
My Commission Expires:
- a7 --,o?6J�
APPROVED BY
►ae`Voie s b Of
MY Commfssfon EE 182608
Expires 04/2712018
(Revised 07 /10 /07)(Revised 06 /10=09)(Revised 3/15/09)
The foregoing instru ent was acknowledged before me this-L9�
day of ✓v` , 20 L, by hSYl
who is personally known
NOTARY
Sign: �S►G� -COX
Print:
My Commission Expires:
m f '�
' 0 em i
f ,
`1 —ar— e>-a14
Plans Examiner Zoning
Structural Review Clerk
:cw A P EXPRESS AIR CONDITIONING &
REFRIGERATION INC
:ux AHMIED PIEDRA FIRES
6051 NW 198 TERR
MIAMI FL 33015
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MIAMI- DE COU 2012 LOCAL BUSINESS TAX R t CEIPT 2013
TAX COLLECTOR MIAMI -OADE COUNTY - STATE OF FLORIDA
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WS P AOE j
140 W. FLAGLER ST. EXPIRES SEPT. 30, 2013
1st FLOOR MUST BE DISPLAYED AT PLARF BUSINESS
PAP)
NIAIA FL
PEST 9G4i.
MIAMI, FL 331.30 PU T T r CODE !CHA , R 0A - ART 9 & 10
THIS 10 NOT AIMLLDO NOT PAY
RENEWAL
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A P EXPRESS AIR CONDITIONINS $ STATE# CA 68
REFRIGERATION' INC
6051 NW 198:TERR
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:cw A P EXPRESS AIR CONDITIONING &
REFRIGERATION INC
:ux AHMIED PIEDRA FIRES
6051 NW 198 TERR
MIAMI FL 33015
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SEE OTHER SIDS —
From: 03/15/2013 09:04 #617 P.001/001
THIS CERTIFICATE IS CERTIFICATE OF LIABILITY INSURANCE 03/15/13
"li*6-ACA hiAftk& WbiWANM ONLY AND d&&iRS NO RIGdiTS UPON 1 tiE CERTIFICiM1TE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE
BELOW COVERAGE AFFORDED BY THE POLICIES
- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING WSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE cwnmae HOLDER.
IMPORTANT- ff Ow n"W8 FWM8r Is an ADDrnOMAL INOutmu- the WIWWS) must be WNUBIWGATIONIS MIAWED
the tomw ancl =k2tl0nS Of the Polley, CWtdn wmoysw* Ir
carlificate holder In Neu of Such P01101- AW reQUI(O an wXf*nwMft A 9WOMM 00 ewdftde do" not comer rWft to #w
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PH - ONE
8300 West Flagler Suite 114
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Miami, FL 33144 net
Phone (305 CO-VOtAft
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A.P. Express Air Condftioning and RgIripration Inc
6051 NW 198 Terrace
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Hialeah. FL 33016- (788)252-7224
COVERAGES
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CERTIFICATE MAY 86 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEOTTO ALL THE TERMS.
EXCLUSXW AND CONDITIONS OF
LpSM SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW.
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DBSCPPTIONOFOPEFtATUMILOCATRWIVEHIMM (Aftch ACORD i0i. Add MoWPAmwksododul%ff came q=GlSFOqUk*O
City of Miami Shores Vfte
10060 NE 2 Ave
Miami Shores, F133138
.30"23-7993
ACORD 25 (2010/05) OF
CANC91-LATIM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE TiWREOF, NOTICE WILL BE DELWAW IN
ACCORDANCE VM THE POLICY PROVISIONS.
AUTH OR RED p"R
Lucia Estrella
0 INS-2010;WORI) CORPORATION. M rights r toad.
The ACORD name and logo we registwW marks of ACORD