PAINTPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date Pl, c,- 9 .-/99L Job Address 10 77 AL E . 91 TERRcE Tax Folio, ,l/ f' S l t 2 f
Legal Description 1 /2 E ' 4 10 + Let # 11 5." 1 _
Master Permit 4 #,307"1 ,9j'
Owner's Address 1077 N. C . 91 TERRACE Phone 6 73 3 9 i �
Contracting Co. Address
SS# - - Phone
Owner / Lessee / Tenant NE1rSal TUMAN1
State # Municipal # Competency 4>: Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION PPt I NT t y i ldi2 !/ � ,
144/AY
Square Pt. Estimated Cost(value) 2 0 0 COO
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 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 compliance with all applicable laws regulating construction and zoning. Furthermore, I
authorize the above -named contractor to do the work stated.
Signature
Date:
of owner and /or Condo President Signature of Contractor or Owner- Builder
Date:
Not y as to Owner and /o{�Otgiici6B0i.eWiTleiftFLORIDA
M Y COMMISSION EXPIRES A
My ommission Expires: P R
IL 16. 1992
BONDED THRD STEMBLER.ADAMS d SWEET
** *
FEES: PERMIT _5 2,56 RADON C.C.F.
APPROVED:
Zoning
Fire
uildin
Mechanical Plumbing
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * * * * * * **
NOTARY ST TOTAL DUE AO tO
Other
I /2I Electrical
Engineering