ELECTRICALPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
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Date - rc Job Addressl / 3 �/% � � %.��✓ Tax
Legal Description
Owner / Lessee / Tenant
Owner's Address / / c3
Contracting Co.
Qualifier t .3(,/-'015/1/4-)
Stated D 2 Q 34"
Architect/Engineer.
Bonding Company
Mortgagor
lotary as to Owner and /or Con
fy Commission Expires:r'
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Competency 0
• o President
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'ERMIT FEE: APPROVED: :_;� : �. -rw� .: 'Fire
Zoning Building
Address
S SA -
Address
Address
Address
Folio
Master Permit j
Phone
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Phoneia ^
Ins. Co.
Permit Type (circle one): BUILDING ELECTRICAL) PLUMBING MECHANICAL PAVING FENCE SIGt;
WORK DESCRIPTION
Square Ft. Estimated Cost0'
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.
DWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and thct all work
eiil be done in compliance with all applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to do the work stated.
ignature of Owner and /or Condo President Signature of Contractor or Owner - Builder
?ate: Date: -, ),`y-
A �.
Notary as to Contractor or Owner - Builder
My Commission Expires;
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Other : � n , Jr✓
Electrical
Mechanical Plumbing Engineering
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