FENCE PERMITInspection Number: INSP -20367
Permit Number: FW -6 -06 -1652
Inspection Date: 09/21/2006
Inspector: Desharnis, George
Owner: PALMER, MARTIN
Job Address: 469 91 Street NE
Miami Shores Village, FL 33138
Project: <NONE>
Contractor: PALMER HOLDINGS, INC
Building Department Comments
Wednesday, September 20, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
LL
a-17 2
2,U'
Block:
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number
Parcel Number
Lot:
305 - 310 -4673
PARC2004 -16
Phone: 305- 310 -4673
Page 1 of 2
D
Inspector Comments
Passed
)(
.,i . ,1 � 1j,, L
Failed
--- i s
— --e
/ .
Correction
Needed
9 ) ',/ ,/ ,9 .......2
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspection Number: INSP -20367
Permit Number: FW -6 -06 -1652
Inspection Date: 09/21/2006
Inspector: Desharnis, George
Owner: PALMER, MARTIN
Job Address: 469 91 Street NE
Miami Shores Village, FL 33138
Project: <NONE>
Contractor: PALMER HOLDINGS, INC
Building Department Comments
Wednesday, September 20, 2006
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
LL
a-17 2
2,U'
Block:
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number
Parcel Number
Lot:
305 - 310 -4673
PARC2004 -16
Phone: 305- 310 -4673
Page 1 of 2
BUILDING
PERMIT APPLICATION
FBC 2001
s:-
Owner's Name (Fee Simple Titleholder)
Owner's Address
City
Tenant/Lessee Name
Contractor's Company Name_'
Contractor's Address
$ Value of Work For this Permit
Type of Work: ❑Addition ['Alteration
Describe Work:
Total Fee Now Due $ 12• -
(Continued on opposite side)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
State Zip
Permit No.
Master Permit No.
Phone #
Phone #
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip _
is Building Historically Designated YES NO
Phone #
City . //. State Zip.
Qualifier f ` r 1— t �% ./
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Square Footage Of Work:
* * * * * * * * * * * * * * * * * * * * * * * * * * ** Fee * ** *** * * ** ** * * * * *** * * ** ** * ****
Permit Type (circle): J3uildnig a trical "' " " " " "'P- pumbing Mechanical Roofing
N
Submittal Fee $ �� Permit Fee $ IOC) .. CCF $ 1 / . - ' CO /CC
Notary $ Training/Education Fee $ Z. ' e % Technology Fee $ / to
Scanning $ 7. ( C : Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
❑ Repair/Replace ❑ Demolition
{ ; I a 1
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: 1 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 INTENT) 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 appproved and a reinspection fee will be charged.
Owner or Agent
The foreoing instrument was acknowledged before me this 1 C I
dayof.JJ( , 200' by kf1 - T I r i )- TC ;1'
who is personally known to me or who has produced
Sign:
Print:
APPLICATION APPROVED BY:
chc 05/13/03
mission
My Com ission Expires: es: SEP 27, 2009
flru Atlantic Bonding Co., Inc.
L a As idenp1fica on and who did take an oath. L as identification and who did take an oath.
NOTA'Rll PUBI1,1C. NOTARY PUBLIC:
'' i: fl ilC - STKi ,. tai∎ Sign:
Print:
My omniission Jes '
* * * ** .* ***************************** * * * * * * * * * * * ** * *** ** ** * ** * * * * * ** * * * * * * *****v:: * ** * * * ** r * * * * * * * * * * * ** * * **
******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
/
/r'
b�; ��
Signature /' ,��
Contractor
The foregoing instrument was acknowledged before me this I
day of _A7'e , 2Ek: 4_. ,sby '1> (t Yl t rrl
who is personally known to me or who has produced
. • i'.!1;;CUE OF FLORID
?r fencing Co., Inc.
* * * * * * * * * * * ** ********* * * *x. * * * * * * * * * * * * * * * * * * * * * * * * **
(e/V'd G
Plans Examiner
Engineer
Zoning
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: I tit 1 VI4d FAA �`N j-. IjATE: CQ
S r
ADDRESS: �I' ,( 9s PJE I "�fl, �- , 1 , j .
Do hereby petition the Village of Miami. Shores to act as my own contractor pursuant to the laws
of the State of Florida, F.S 489.1.03(7). And I have read and understood the following disclosure
statement, which entitles me to work as my own contractor; I further understand that [as the
owner must appear in person to complete all applications.
State Law requires construction to be done by a licensed contractor. You have applied for a
permit under an exception to the law. The exemption allows you, as the owner of your property,
to act as your own contractor even though you do not have a license. You must supervise the
construction yourself. You may build or improve a one- family or two - family residence. You may
also build or improve a commercial building at a cost of $25,000.00 or less. The building must be
for your own use and occupancy. IIt may not be built for sale or lease: If you sell dr lease a
building you have built yourself within one year after the. construction is complete, the law will
presume that you built for sale or lease, which is a violation of this exemption. You may not hire
an unlicensed person as a contractor. It is your responsibility to make sure the people employed
by you have licenses required by state law and by county or municipal licensing ordinances. Any
person working on your building who is not licensed must work under your supervision and must
be employed by you, which means.thatyou must deduct F.I.C.A and with- holdings tax and
provide workers' compensation for that employee, alias prescribed by law. Your construction
must comply with all applicable laws, ordinances, buildings codes and zoning regulations.
Please read and initial each paragraph.
1. I hold title to the above property and I am planning on doing this construction
Initial
2. I understand that as an owner - builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application
Initial
3. I have an understanding of the 2004 FBC & FRC and understand that this
department and its inspectors are there to help enforce and interpret the code.
There is a copy of the code in this office for review.
Initial
4. I understand that the building official and inspectors are not there to design,
alter or give advice on how to meet code —. only if the structure meets the
minimum code.
5. I understand that as an owner - builder, that any contractor disputes with sub-
contractors and myself must be handled in a civil court with the advice of an
attorney. The department will not mitigate'any contract disputes.
6. I understand that if I compensate any person or company for work performed
they are required to have a business license in the county. If for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company-or person.
7. I understand that if any person gets injured on my construction project —they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
loss of wages during recovery from injury.
Produced there License or
Initial
Initial
Initial
8; I. understand that under state and local laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on my property with out first obtaining
the proper permits by licensed contractors.
Initial
Was acknowledged before me this 16311 day of , 20 �Cnt::=
r who was personally known to me or who has
as identification.
C STA' OF,CgIDA e�
���n�c ��� ' �e�and
' YOg�.� #D7645
t► A', it4
Issue Date: 6/26/2006
Owner's Name: MARTIN PALMER
Permit Type: Fence /Wall
Work Classification: Wood Fence
Job Address: 469 91 Street NE
Additional Information
Miami Shores Village, FL 33138
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Expires: 12/23/2006
Contractor(s)
PALMER HOLDINGS, INC
Phone
305 - 310 -4673
Primary Contractor
Yes
Com ments:
INSTALL WOODEN FENCE 50' AT REAR ORP PROPERTY LINE PLUS 10 ' EACH
SIDE OF THE HOUSE
Type of Construction: Wood Fence Additional Info:
Classification: Residential
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 either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do
the work stated.
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee - Wire & Wood
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$5.00
$100.00
$3.00
$2.50
$112.10
Building Department File Copy
Applicant Signature
Parcel #:
Block:
Section:
Foundation
Final
Total Square Feet: 0
Total Valuation: $ 1,750.00
Required Inspections
Invoice Number Amt Due
FW -6 -06 -25345 4112
coq
Total: �r - ,r
ermit Status: APR OVED
Permit Number: FW -6 -06 -1652
Phone: 305 -310 -4673
PARC2004 -16
Lott:
PB:
Amt Paid
NOTICE: In addition to the requirements of this permit, there may be additional
restrictions applicable to this property that may be found in the public records of
this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES .
9
/CD
•
•
•••
6
•
•
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•
•
• • . • . •.. • LOCATION MAP
• • ••• • • • • •.•
• •• ..
• • • • • • • •
��•
,_ A • • • • t 17/.� •__•_ - -. •_ S7 - -
S •-
V' // •y /• 11 1. ••( • t•
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22
50•
PROPERTY ADDRESS: 465 N.E. 91st
LEGAL DESCRIPTION: Lot 21, Block
according to the plat thereof,
at Page 27, of the Public Records
FOR: TALISMAN INVESTMENTS, INC.
(N.T.S.)
SURVEYOR'S NOTES=
1) This survey was conducted for the purpose of a 'Boundary Survey' only and b not Intended to detreate the reguirery
jurisdiction of ery federal, state, regional or bat agency, board, commission or otter entity.
2) The accuracy attained by measurements and calculations on the survey, meets and exceeds the rv&inum Tectnico1
Standards roqu:remente for a Suburban area (1 toot In 7,500 feet) es epadfled to Chapter 81017 -6, Fbrtde Administrative Coda.
3) This Survey doer not reflect or dee - ine ownership.
4) Legal desorption 'subject to ay dedication% imitation%, restrictions reeervedions or easements of record.
6) Examination of the Abstract of Tile wit have to be made to determine recorded Instruments, If any affecting tee property; seotch
d Pubic Records not performed by this oftoe.
S) No orlon was made by this aloe to locate any underground unities and/or structures within or ebutting the subject property.
8 ) This airway has been prepared for the exclusive use of the entice named hereon only end the certifications hereon do not
extend to any unnamed parties.
9) The survey was prepared for a Mortgage Transaction on Not to be uaad tor design and/or construction purposes wit out the
Coaled of.Wb aka.
10) Likely furies° Att e) linty Easernenta not rioted as Voted:ma.
11) DrNavrsye or parlors thereof wleutn Roadways not noted as violations or encroachments.
.
12) Foundation a dlor !mange urtdarrm=h 9ro ground =face tad nay ao'oa beyond the b0undtry Erma of the herein deerescd
parcel ere not °Frown.
13) Ail Iron Ppee or Re -Bard land and °hewn on tie eitech of survey have no caps unless eternise t2id
14) Ferree ownerettp deterrrie by visual means only (f any); Legal ownership not determined.
1 F) No search of records was made by the firm beads the record prat therefore we do not Imply OT except res,pareitXra far cry
Easement, Dedication or Limitation ter which information ens not furnished.
16) Contact the appropriate eL prior to any design wok al the hereon- doaoibod parcel to Striding and Zoning
Information.
17) Proteedonal Land &rveyor and Mapper in raeponslbte charge: Rolando Ortiz LS 4312. ewe at Ratio.
18) The survey is not valid wttwc8 the aelgrulro and the raised seed at a Ronda Licensed Lend Surveyor and Mapper.
Street, Miami, Florida 33138.
49, "MIAMI SHORES SECTION 2 ",
as recorded in Plat Book 10,
of Miami —Dade County, Florida.
B Y:
I hereby eerily to fro above named tarn aed,br persona that the Sketch of Survey at the described property is true and correct to
the beat of my knowledge red belief, are laSenty eurveyed end platted under my daecticn: also that meets the Ntim.rn Technical
Standards set in Chapter 61017 -8, Ronda Administrative Cc le, ;sunward to Section 472.027 Florida Statutes. it F/NOt:. 'zeroes, Soul/ ' 5/444
DATE JOB
A KAMM SKETCH Ni.1116t3t DRAWN BY REVISIO 3 6 .1.7005 (dP -Da 76 StJ/gOrY
it APPG; Cy io 'I
PREPARiD BY
`tU[1JECy �® CZ:r .AXLE JAW 7E1 EP
IV GUNTER GROUP, INC.
LAND SUR'VEYNG - LAND PLANNING
FU RDA CLRTEICATE Cr AUTti0RIZAT1AI j LB 4507
9350 S.W. 22nd TERRACE
MIAIdl, FLORDA 33165
(305) 220 -0073
1t�0� i C-D 2_
Fi\
R/W RIGHT OF WAY ENC.
(Mom.) MEASURED C.L F.
(R) RECORD W.F.
(Cale.) CALCULATED CONC.
F.I.P. FOUND IRON PIPE C.P.
FRB FOUND RE -BARD Fitt
FD/H FOUND DRILL HOLE W/;M
F.N. FOUND NAIL
F.N,y do 0 FOUND NAIL @ DISC W.P.
C.O.S. CONCRETE BLOCK L.P.
AND STUCCO P.C.P.
C/B CATCH [MEN P.I.
(rt) TYWCAL P.C.
tt CENTER UNE P.T. E.
U
IA MONUMENT UNE V.
E. 2 PROPERTY IE D.M.E.
Ct CLEAR
AB AT
ENCROACH
CHAIN UNK FENCE
W000 FENCE C
CONCRETE
CONCRETE POLE
FIRE HYDRANT
MAN HOLE
WATER METER
WOOD POLE NAI
LT POLE
PERMANENT CCVTROL POINT
PONT or INTERSECTION
POINT OF COMMENCE
PCNT OF TANGENCY
UTILITY EASEMENT
DRAINAGE Ara
MAINTENANCE EASEMENT
/s V3/2
BY: 'OLANDO ORTIZ LS 4312
OR: RICARDO ORTIZ LS 5629
PROFESSIONAL LAND SURVEYOR
& MAPPER. STATE OF FLORIDA.
.4z -,S -or I 4-t , 20" $ I - ,z,01 17- 15 Poor(o, -49 4 re gvcvcy)
;
if oC
1 .. i le
0
ETE
• 1 AND COO \7Yy RULES AND R .2-I1L AIC \ �
P.
(a.54 Cam -I 025
CL
SKETCH OF SURVEY SCALE 1" a ZO
rda
AC'CORDCNO TO THE NATIONAL ROOD INSURANCE PROGRAM
T1-E SUBJECT PROPERTY FALLS IN ROOD ZONE
CONUC-
30 00
, f g bh N
o ,�� 0 Q
, � h 224
4 O ►^
Vii, so '
/20652.
je t' N
21,90'
! v ha :// "W/O
X7
3 A.T
COAIAI+T6T1' No. PANEL No. SUFRx.
1 -Q, /P
CL
_/{1e6.,_.__ 5/ 5 /a/ez
/
DATE OF FBiM
7/7 -95
N UL)cxD.c
NJ& 4 .
1,
J-0
F90,1 ZONE
,ss.6o
�pbor
BASED ROOD ELEV..
I✓
/.
/7 /6
3' i/
nJ
� 2 7 Q' S
5
20
. 9747
/i
g0'
3 .12
50'
V_ 22 -23 24
�. 30. 55¢2•
PROPERTY ADDRESS: 465 N.E. 91st Street, Miami, Florida 33138.
LEGAL DESCRIPTION: Lot 21, Block 49, "MIAMI SHORES SECTION 2 ",
according to the plat thereof, as recorded in Plat Book 10,
at Page 27, of the Public Records of Miami —Dade County, Florida.
FOR: TALISMAN INVESTMENTS, INC.
LOCATION MAP (N.T.s.)
SURVEYOR'S NOTES:
1) This ewey was conducted for re purpose of a `Boundary Survey' only and le not Intended to dee the regulatory
ur deean al any federal, Seta, regional or boat agency, board, cNmmas:on or other entity.
2) The ecasacy obtained by rtteaxaemants and catpdaJone on this survey, meets and exceeds the Minimum Tochnicel
Standards requirements for e Suburban area (1 foot In 7,500 feet) es specified In Chapter 81G17-6, Flores Administrative Code.
3) This Survey does not re or detennhe ow nerahlp.
4) Legal daemon subject to arty dedications, ItrnlTationo, mordent+ rwerva1 one or comments 01 record.
5) ExamhatIon of the Abepa 3 of Tea vril have to be rrccie to deter: recorded Instruments, B any affecting the property; couch
of Pubic Re sot s rot performed by iris afire.
8) No effort was made by this diem to locate any underground ,. lbea and/or structures within or abutting the elbjoct property.
8) This survey hes been prepared for the exclusive use of the entitles named hereon only and the oerefdatto s hereon do not
of id to any unnamed partleo.
9) This survey wen prepared for a Reengage Transaction only Not to be used to design ad/or coretructon purposes v /urea t the
consent Wets dace.
10) laity far:Wm satin LAlilty Eammenta not noted as vblatioa.
11) DAvewers or portions thereof within Roadways not noted es violations or eneroadrrterrb.
12) Foundations and/or foatYtge a demean the ground a mace that may cross beyond the boundary Ares of Co herein described
pared ore not a own.
13) All Iron Rpm or Re-Bard fend are shown on the sketch of army have no cam Woes ofterwise stared.
14) Fence ownership determine by visual means only C) my); Leger ownership not determined.
18) No search of records wee made by tine aim beside the record plat therefore we do not Hthply or accept rally for any
Eeaarnort, Dodo/don or Linia9an for which irdomialion wars not tarniehod.
18) Contact the appropriate authorities price to any deeign work on the hereon - deserted parcel for Wilding and Zoning
Information.
17) Professional Land Surveyor end Mapper h responsible charge: Rdendo Orte LS 4312, State of Florida.
18) Thee savvy is not valid without the a insane and the reed see Of e Raids Licensed Land Surveyor and Mapper.
/BBREVIATKN\S
R/W RIGHT OF WAY ENC.
(Mem) MEASURED C.L F.
(R) RECORD W.F.
(Cafe.) CALCULATED CONC.
F.I.P. FOUND IRON PIPE C.P.
FRB FOUND RE -BARD F
FD/H FOUND DRILL HOLE rat
F.N. FOUND NAIL W/M
F.N C.B D UND NAIL & DISC W.P.
.. FO CONCRETE BLOC( LP.
AND S1UCCO P.C.P.
0/3 CATCH BASN P.I.
(TE) TYPICAL P.C.
(ENTER UNE P.T.
(B MONUMENT LIKE U.E.
e PROPERTY UNE D.M.E.
CL CLEAR
ENCROACH
CHAIN UNK FENCE
W000 FENCE
CONCRETE
CONCRETE POLE
FIRE HYDRANT
MAN HOLE
WATER METER
WOOD POLE
LIGHT POLE
PERMANENT CONTROL POINT
PUNT OF INTERSECTION
PUNT OF COMMENCE
PUNT OF TANGENCY
UTIUTY EASEMENT
DRAINAGE AND
MAINTENANCE EASEMENT
PREPAIED BY:
GJNIER Cam. INC.
LAND SURVEYING - LAUD PLANNING
FLORA CERTFtCAlE OF AUTKt>RTZADON / LB 4507
9350 S.W. 22nd TERRACE
MIAMI, FLORIDA 33165
(305) 220 -0073
I hereby eerily to the above named firm and/or pereone Rat to Sketch of Survey of the described property is true and Coned to
the beet of my knowledge and baler, ere recently aaveyect and pled under my direction; ado that meets the Prot T .rn Technical
sStamderat Bet in Matter 61017 - Folds Adminlatreeve Coda, gunroom 10 Sodden 472.027 Ronda Stsartee. it Fn4O(. gacre.0 SOreigY: Cl/ 441 BY: ' r- D0 ORI1Z LS 4312
OR: RICARDO ORTIZ LS 5629
DATE ` on pee, tL (/P 76 scifee f�/ I PROFESSIONAL LAND SURVEYOR
4-c -or $- 2a 9 200 T 4 I wN By- 6'B'Zs 10Z,4f I 7- /s- ZoOr 00 T# sti
& MAPPER. STATE OF FLORIDA.
,
oz
a`
I
/47
J CL ,
SKETCH OF SURVEY SCALE V ° g ®
99L
4
0
—'a
emNUC-
,
30.00
-5/ S /deee/a /e --
Parkeay
ACCORDING TO ThE NATIONAL ROOD INSURANCE PROGRAM 1 No. I AN EL
THE SUBJECT PROPERTY FALLS IN ROOD ZONE: /2o652.. 93
61°b
66'
CL
N
025'
CL ,
E. 91s ST
of,vho; fiaw_n:c
SUFRX I DATE OF P981
i 7
FORM ZONE
BASED ROOD a.EV.
I ate - No 1 (QJob Address _! 4 ^E - f 1 Cr Tax Folio
— Legal DescriptionL.* \ 1 .. ,71- ® C_ r dcq
5, € er &se Cc e C � q 0=
��S i ...)e5,5 �? � � Master Permit # �
Owner's Address 9 i 0 9"-i s , u: -A--V BY - re' 0 Phone G 1 7 y
Address ,....-.
Owner/Lessee / Tenant
Contracting Co. �, i )
Qualifier c‘3 -e-�
SS# - Phone
Municipal # - Competency # Ins. Co.
Architect/Engineer / Address
State # N r'
Bonding Company
Mortgagor
Square Ft. c
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
e o owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT L i t e 9 . RADON
Historically Designated: Yes No
Address
Address
Permit Type (cirefle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK t ESCRIP'fION P D I 1 L I Q c eAk 1C9
Estimated Cost (value)
'WARNING T4 (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.
OXIAQ) Q--------- 61 - " g'Qom;
Si a ontractor or Owner- Builder Date
$
T
Not as to Contractor or Owner - Builder Date
My Commission Expires:
C.C.F. - c-C NOTARY BOND
TOTAL DUE
�r.
APPROVED:
Zoning Building )6t)/619le. Electrical
Mechanical Plumbing Engineering