MC-15-2420 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756.8972
Inspection Number: INSP-250445 Permit Number: MC-9-15-2420
Scheduled Inspection Date:January 11,2016 Permit Type: Mechanical - Residential
Inspector Perez,JanPierre Inspection Type: Final
Owner. , Work Classification: AIC Replacement
Job Address:102 NW 108 Street
Miami Shores, FL 33168-4313 Phone Number
Parcel Number 1121360100010
Project <NONE>
Contractor. UNIVERSAL AIR CONDITIONING CORP Phone: (305)822-9210
Building Department Comments
NEW INSTALLATION A/C 5 TONS Infractlo Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-244037. missing lock cap,seal
hole in closet, fix dryer duct, replace return grilles
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
January 08,2016 For Inspections please call: (305)762-4949 Page 25 of 35
t
Miami Shores Villagef '
a
10050 N.E.2nd Avenue NW
Miami Shores,FL 33138-0000
Phone: (305)795-2204 "Wawm
�w t :
` ' ,.;
� Expiration: 03127/2016
Project Address Parcel Number Applicant
102 NW 108 Street 1121360100010
DOUBLE TT LLC
Miami Shores, FL 33168-4313 Block: Lot:
Owner Information Address Phone Cell
DOUBLE TT LLC P.O.BOX 90393
KEY BISCAYNE FL 33149-
P.O.BOX 90393
KEY BISCAYNE FL 33149-
Contractor(s) Phone Cell Phone Valuation:
$ 7,000.00
UNIVERSAL AIR CONDITIONING COR (305)822-9210 (305)887-5514
Total Sq Feet: 0
Tons:5 Available Inspections:
Additional Info:NEW INSTALLATION A/C 5 TONS Inspection Type:
Classification:Residential Final
Approved:In Review Review Mechanical
Comments: Date Approved::In Review Review Mechanical
Date Denied: Type of Work:
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $4•20 Invoice# MC-9-15.57184
DBPR Fee $3.68 09/29/2015 Credit Card $272.56 $0.00
DCA Fee $3.68
Education Surcharge $1.40
Permit Fee $245.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $272.56
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by eith myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DO S,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing' format o is t d that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the a ve-na co the work stated.
September 29,2015
Authorized Signature:Owner / Applicant / Contra o / Agent a e
Building Department Copy
September 29,2015 1
Miami Shores Village RFcT� r�'
Building Department SEP 2 3 7015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY--
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 a
t
LI- 20-10
BUILDING Master Permit No. R C I
PERMIT APPLICATION Sub Permit No. NC- t5-211-t ZD
BUILDING ❑ ELECTRIC ROOFING ❑ REVISION EXTENSION RENEWAL
❑PLUMBING [MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
JCONTRACTOR DRAWINGS
JOB ADDRESS: 14 Z' �"w 0? S,!
City Miami Shores ✓ County: Miami Dade Zip:
Folio/Parcel#: is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):� LC Phone#:-AQ�t�� a`� 53
Address: R o bosC L Ca03a-? (?� -
City: C�i�,QtA- State Zip:
Tenant/Lessee Name: Phone#:
Email: c�
CONTRACTOR:Company Name: v <r2 f '`"'�~� Phone#:
Address: ?Z Z r A/-1A) �'6 S
City: lk/,4 /;I f State: �U Zip:
Qualifier Name: 71-A V i y 44'9-rev Phone#:
State Certification or Registration#: C`% �� �� Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �� 0&0 r Square/Unearr Footage of Work:
Type of Work: ❑ Addition
B ❑ Alteration ❑ New ,[IBJ-Repairer/Replace ❑ Demolition
Description of Work: /V jet JV s/ � I(�' d� b\NC 0�
Specify color of color thru tile:
av
Submittal Fee$ SO . Permit Fee$ w" CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
f
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS,HEATERS,TANKS,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 dve red to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must a A osted at the job site
for the first inspection which occurs seven (7) days after the building permit is issue In the absence of sucl i posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing trument was acknowledged before me this
/_day of SF.P t CM1864R- ,20 (r by Z day of 20 by
90bV jU/Ir ti(?D TA ,who is personally known to - V 1+e-/' /,�D�=who is personally known to
me or who has produced as me or who has produced f-TSL as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign.• �- Sign:L2-.��: ;:Z2
Print: LMA Ak - F VC. .�t F—S Print:
Seal: 4e �ry pwft Stgw of Florida eal:
. l.idi8 M Fuentes �°o% Notary Public State of Florida
My Commission EE 841144 ; Joanna M Feliciano
+� My Commission FF 082753
or E 10109/2018 +� Expires 01112f2o18
e�*�+*re**�r,se*s*e*ees+w eee• e e ex�+xxes*e****e�+
APPROVED BY lans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RICKSCOTT GOVERNOR KEN LAWSON,SECRETARY
` STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
CAC057783
The CLASS B AIR CONDITIONING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
o� • a
MATOS, JAVIER W _
UNIVERSALAIR CONDITIO"_ CORP
7228 NW 56TH ST
MIAMI FL-331661 _
ISSUED: 0826/2014 DISPLAY AS REQUIRED BY LAW SECI# L1408260001451
a•
ummn
Local Business Tax Receipt
Miami-Dade County, State of Florida
THIS IS NOTA BILL - DO NOTPAY
3995694 . LB
BUSINESS NAMe/LOCATION RECEIPT No. Tj
EXPIRES
UNIVERSAL AIR CONDmoNING CORP RENEWAL SEPTEMBER 30,1015
7228 NIN 56 ST 4170056 Must be displayed at place of business
MIAMI FL 33166 Pursuant to County Code
Chapter RA-Art.9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT'RECENED
UNIVERSAL AIR CONDITIONING CORP 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR
wo*er(s) T CAC057763 $75.00 08/08/2014
CREDITCARD-14-032018
This Local Basinu Tax Receipt only me=psymeot of tm Loca1 Bgsrmm Tax.The Receipt is aot a license,
permit ora cerdticatoa of the holder'sgallRcateas.to do business.-Hol der a t am*with any gored
er aoagovermneami regulatory haus and tegairements which apply to the b�i�as.
Th9 RECEIPT NO-alcove mast be displayed on aU inial vehicles-Mimd-Bede CWe Ssc&e.M
For nmre WwmW M vhdt
CERTIFICATE OF LIABILITY INSURANCE �"9/092015"''
o9io9nols
ICER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
THE CHAESTELI GROUP CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
5400 S.UNIVERSITY DRIVE SUITE#405 COVERAGE AFFORDED BY THE POLICIES BELOW.
DAVIE,FL 33328 INSURERS AFFORDING COVERAGE NAIC#
954-583-3838
INSURED INSURER A ASCENDANT
UNIVERSAL AIR CONDITIONING CORP INSURER B:
7228 NW 56 ST INSURER C:
MIAMI FL 33166 INSURER D-
305-887-5514 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR LTR ADD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MMIDWYY) DATE EXPIRATION MMOMM LWITS
A ® GENERAL LIABILITY GL-45992-0 10/25/2014 10/25/2015 EACH OCCURENCE $1,000,000
®COMMERICAL GENERAL LIABILITY DAMAGE TO RENTED $100,000
00CLAIMS MADE ®OCCUR aw
PREMISES Ea ortenc*
MED EXP(Any one person) $5,000
❑
PERSONAL&ADV INJURY $1,0()0,000
❑ GENERAL AGGREGATE $1,000'wo
GEWL AGGREGATE LIMIT APPLIES PER
®POLICY❑PROJECT❑LOC PRODUCTS-COMP/OP AGG $2,10IMPp
❑ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
❑ANY AUTO (Each Omurence) $
I
❑ALL OWNED AUTOS BODILY INJURY $
❑SCHEDULED AUTOS (Per per)
❑HIRED AUTOS BODILY INJURY
❑NON-OWNED AUTOS (Perart) $
❑ PROPERTY DAMAGE $
(Per accident)
❑ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
❑ANY AUTO OTHER THAN FA ACC $
❑ AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
❑ ❑OCCUR ❑CLAIMS MADE AGGREGATE $
❑DEDUCTIBLE $
❑RETENTION $ $
WORKERS COMPENSATION AND WC❑ OTH-
B ® EMPLOYERS'LIABILITY TORY LIMITS ER
ANY PROPRIEfOR/PARTNER/EXECU- E.L.EACH ACCIDENT $1,000,000.000
TIVE OFFICERMIEMBER EXCLUDED?
If yes,descrbe under E.L.DISEASE-FA EMPLOYEE $1,000,000.000
SPECIAL PROVISIONS below
EL DISEASE-POLICY LIMIT $1,000,000.000
❑ OTHER
AIR CONDITIONING CONTRACTOR,SERVICES AND INSTALLATIONS.
CERTIFICATE HOLDER CANCELLATION
CITY OF MIAMI SHORE VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
10050 NE 2 AVENUE EXPIRATION DATE THEREOF,THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT,BUT
MIAMI SHORE ,FL 33138
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHOFMD REPRESENTATIVE
ACORD 26(2001108) 0 ACORD CORPORATION 1988
6
JEFF AIWA ER �}
CHIEF FINMCl/4.OFFICER STATE OFFLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
CERTIFICATE OF ELECTION TO BE EXEMPT FROM R.ORIDA WORKERS'COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exemptfrom Florida Workers'Compensation law.
81 BECTWE DATE: 4/26/2014 EXPIRATION DATE 4/2512016
PERSON: MATOS JAMER
FEIN: 660189690
BUSINESS NAME AND ADDRESS:
UNIVERSAL.AIR CONDITIONING CORP
7228 NW 56 ST
MAN FL 33166
SCOPES OF BUSINESS OR TRADE:
HEATING,VENTILAMON,
AIR-GOND q�
PtasamdbCtapter44U5(i4).FS,reaffcerdeaarporeffmvAmeleats an4antlds rbyAl eaerl�c�ofalectla�antertldsssdianmay
not ream 6 a aarrgrermetiaanaxlar gde d .Purawd lo C! l .x(12)F.S„C oats ddedion to be e�mpL.apps o��yy��{{tldn 6�s scope
d8�e buslress or tradoli�!an Ove notice ddeatlon to be wmq)L Purauard to Ctsrpler 44408(1 ,F.S..NaOras deiac8ar be aaf oerEladm d
dadmtob000y#ddibeoete rmlorit n ft ngtd�i'mwb d0ft sedan for I d s�cwi0 �p edeperbnad sW redroa cerdlicato ataiytim ror faller dit
per=;=.ed arthocaModetoniWtreregtdrern bdOdssengam
DFS-F2-DWC••262 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(860)413-11109
A .
Noun 121 % Miami shores Village
Building Department
I.pR ► 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
7777
z77
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,must obtain workers'compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation,or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature: V-
r
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this I(o day of S5JFr64 V16 F—e ,20 �S .
By R.W AYVA [30*b M'T who is personally known to me or has produced
as identification.
Notary:
SEAL:
KNO" ublic State of Florida Fuenta
rmisaton EE 841144
State Mechanical Contractor 7228 N.W 56 ST
• CAC057763 Miami, Florida 33166
- Residential - Commercial CONDITIONING Phone: 305-887-5514
- IndustrialNREW Fax: 305-887-5519
DATE; SEPTEMBER 22,2015
STATE OF FLORIDA
COUNTY OF MIAMI
BEFORE METHIS DAY PERSONALLY APPEARED JAVIER W.MATOS WHO
BEING DULY SWORN,DEPOSES AND SAY;
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT
LOCATED AT ; 102 NW 108 ST MIAMI SHORE .
SWORN TO(OR AFFIRMED) AND SUSCRI13ED BEFORE ME THIS 22 DAYS OF
SEPTEMBER 2015.
PERSONALLY KNOW- ------------- _ ____
OR PRODUCED IDENTIFICATION-------------__�____w �Mw__�_______�_
TYPE OF IDENTIFICATION PRODUCED---L---M'72 c,13 S ct ^V Z?
e a ISOL HIDALGO
€. MISSION#FF023893
•s9�Or W�•
E IRES June 4,2017
(407)398.0183 ®P 9ANGEa Service.com
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$��c.19aa
l•.• ap C 1 40 Miami shores Village
Building Department
R 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305)756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and_C- actor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS NAME: I /OU1 54� liQ C 0 A'Q!t I,0A11yV( COPP .
V
BUSINESS ADDRESS: ! Z Z 6 7 CITY 1 19 STATE F 14 ZIP
BUSINESS PHONE: 3OJ^ P7�S I F ?0� ( $7 JI I
� NUMBER(
CELL PHONE( ��J 1got).-Z 121 d QUALIFIER'S NAME: 4'4 Ll L L— o' /11'q G �r
QUALIFIER S LIC NUMBER:
C
MIAMI-DADE COUNTY-STATE OF FLORIDA N/A October 15.2015
MIAM LOCAL BUSINESS TAX RENEWAL
® 2015 -2016 APPLICATION RECEIPT:4170056
3995694 STATE#CAC057763
DBAIBUSINESS NAME: BUS.COMMENCEMENT DATE:10/01/1998
UNIVERSAL AIR CONDITIONING CORP SEC TYPE OF BUSINESS
BUSINESS LOCATION: MECHS SPEC MECHANICAL CONTRACTOR
7228 NW 56 ST 1
MIAMI,FL 33166
APPUCA71ON DETAILS
OWNERICORP.
UNIVERSAL AIR CONDITIONING CORP FEE AMOUNT
PHONE# 306-822-9210 Receipt Fee 30.00
DMSA Fee 30.00
ST Beacon Council Fee 15.00
7228 NW 56
MIAMI,FL ST Bingo Permit Fee 0.00
Nightclub Permit Fee 0.00
Multi-Municipal Contractor Fee 0.00
Restricted Contractor Fee 0.00
Library Fee 0.00
Transfer Fee 0.00
NAICS CODE: 238990 Doing Business without a License Penalty 0.00
Late Penalty 0.00
Collection Cost 0.00
NSF Fee 0.00
Prior Years Due 0.00
Amount Recently Paid - 75.00
TOTAL AMOUNT DUE: 0.00
.................................................................................................................................................................................................................................................................................................................
If no longer In business,please notify us In writing. To pay online go to www miamidade.aov/taxcollector
Review and correct the information shown on this application. To pay by mail,make check payable to:
Miami-Dade County Tax Collector
A 25%penalty will be assessed to anyone found operating Business Tax
without a paid local business tax,in addition to any other 200 NW 2nd Avenue
penalty provided by taw or ordinance(Sec 8A-176(2)). Miami FL 33128
To pay in person go to:
A Certificate of Use and/or City Business Tax 200 NW 2nd Avenue
Receipt may also be required. (305)270-4949,fax(305)372-6368
A service fee of not less than$25.00 up to a minimum of 5%
will be charged for all retumed checks.
t RETAIN FOR YOUR RECORDS t
.................................................................................................................................................................................................................................................................................................................
MIAMI-DADE COUNTY- + DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT + N/A October 15,2015
STATE OF FLORIDA RENEWAL
LOCAL BUSINESS TAX RECEIPT:4170056
2015 -2016 APPLICATION STATE#CAC057763
3995694 11111111111HININ
BUSINESS LOCATION:
7228 NW 56 ST
MIAMI,FL 33166 BUS.COMMENCEMENT DATE:10/01/1998
SEC TYPE OF BUSINESS
OWNERICORP. MECHS SPEC MECHANICAL CONTRACTOR
UNIVERSAL AIR CONDITIONING CORP 1
APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION
OR OCCUPATION DESCRIBED HEREON.I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT.
I SWEAR THAT THE INFORMATION IS TRUE AND CORRECT.
UNIVERSAL AIR CONDITIONING CORP
JAVIER MATOS PRES
ST SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE
7228 NW 56
MIAMI,FL ST Please pay only one amount.The amounts due after Sept 30th include penalties
per FS 205.053.
KReceived By Oct 31,2015 Nov 30,2015 Dec 31,2015 Jan 31,2016
Please pay $0.00 $0.00 $0.00 $0.00
7000000000000000000000004170056201600000007500000000000001