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Date
PERMIT APPLICATION FOR MIUNICIPALITIES
(OWNER TO RETAIN COPY)
Job Address \\32) ° 1
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Legal Description
Owner J Lessee /
Owner's Address
Contracting Co. WASTE MANAGEMENT OF DADE COUNT2dress 660 S.W. 3 AVE FLORIDA CITY, FLA 33034
Qualifier JERRY STITH SS# Phone
State# 00- 157434
Architect /Engineer
Bonding Company
Mortgagor
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Competency # 000014780/18806 Ins.CoNEAR NO INS AGENCY
Address
Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION TEMP WATER CLOSET
CUSTOMER NAME & ACCT#: ( c O�V�C--K. > (670Q-
Square Ft. U/N - Estimated Cost U/N
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 constru on in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, LUMBING 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 applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to do the work stated.
Signature of Owner and /or Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
* . * . * * * *
PERMIT FEE: APPROVED:
Zoning
Mechanical
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Fire
Signature of Cbntr ctor or Owner - Builder
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OFFICIAL NOTARY SEAL
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* COMMISS{ON NUMBER
Q A603276
F MY C MISSION EXP.
1F Ft° MAR. 29,1994
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Tax Fol
Master Permit
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Phone
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Contrac
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Other
Building lectrical
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OF DADE COUNTY
247 -1000 x -259