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PAINT PERMITPERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /" - 9 Job Addre � / '7 5. Tax Folio • Legal Description Sec 3 9 q- i f it 64-0/ 5 Historically Designated: Yes No Owner/Lessee / Tenant iN /'D �//CL y N f3 2 C /7' Master Permit # 3 %) 1 Owner's Address 7 ` d E 9/ -- Phone Contracting Co. /v //3 Address Qualifier Al /A- SS# State # +-- . Municipal # Competency # _ Architect/Engineer '14 Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 49 " // fir Tf �o� c/�"S� >A -�" �.� //Y1 /d Cr tT o /44-i /3,4-s Y (w/ Square Ft. t Co o Signature of owner and/or Condo President Date Estimated Cost (value) 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 c to do the work stated. od /4_ Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner- Builder Date My Commission Expires: My Commission Expires: FEES: PERMIT APPROVED: Zoning Mechanical Building Plumbing %/;I Electrical x es,2 t 0 Signature of.6errtP ror caner -8 F Date RADON C.C.F. NOTARY TOTAL DUE Engineering /R3Y?W> u ,'c/i Nal-0 5 r Enclosure Address 6.Yw 5 461 G'7 3 L s 9)--i /Jr 95 / 2- -5 i/ e Home Telephone Repair Business Tee hone j '- - r3t. 7.(7 - ,s Alteration Interior Fax Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other Step 1. Step 2. •. •. • • • • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • • ••...•• •••• Master Permit No. PERMIT APPLICATION • ... • .•. • • • • • • • • Subsidiary Permit No. • . • • . . • • • .. • • •••• •• • INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Complete the attached peptit aVItation wl ieh mast1ne sigred by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a mortiecuiati • processing of your application. If roofing work will be done, a roofing application must be submit- • • � • •• • • ted along with this permit application. • • . • . •• • • • • • ••• •• Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: So /YEW/ $r Address Apt. Folio Number l/ 3/ 01 .02 0 0 0,30 Lot ecT /– G S Block /$ Subdivision Py PB ¢ dS PG Current Use of Property S t v,r ye,l, Proposed Use of Property 5 d41∎)Z_ Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection Fence Other Name ARCHITECT License No. Addres Teleph .51r-45.-$ City Zoning Linear Feet Square Feet Lloa Units State Zip escription of Work / Tb QN 1 Floors 1 Value of Work to t Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. License No. ENGINEER Name Address Telep e Name ax CONTRACTOR License No. Address Telepho Fax alifier Name Page 2 IMPORTANT NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR V$LIpArEZ) PERM1t AND PERMPIICARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7`.� a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITLQN free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROVDIR'I »Jr DEBRISt' • • • 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMI;[1`f OR AiN1) WkY•NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. • • • •• • • : • • • • • • • •• 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE %..\ .\\ Signature of Owner Signature of Contractor / Qualifier E4" i i 'V E L y/V & iT CH Type of Identification Produced: • • • • • • ••• • • • • • • • • • • • • • • •• ••••••• : PERMIT APPLICATION Print Name /A Print Name D t�a subscribed before me this I// � day of Sworn to and subscribed before me this day of Si at of ot� bl `' :' � OFFICIAL NOTARY SEAL Signature of Notary Public - State of Florida n JULE F PAUL( SEAL: 1 F * COMMISSIONNUMBER SEAL: 00066088 c MY COMMISSION EXPIRES OF F\. OCT. 21,2005 Personally known OR, Produced Identification Personally known OR, Produced Identification Type of Identification Produced: SECTION BY DATE Zonin: / �,i 0 Electrical Mechanical Plumbing Fire Public Works Structural Building Official �� /W Page 4 OFFICE USE ONLY ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) LI CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) • ❑ PROOF OF OWNERSHIP' (Attach) ••. • •• ••• ❑ HRS / DERM APPROVAL •; (Septic / Sewer) ••: ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) • • .• • • • •• •• • • • • • • • • • • . • • • • • • • • • • • • . • PERMIT APPLICATION • ••• • CHECKLIST • CONDU SSOCIATION APPROVAL (Attach) . • • • • •. • • • • • • • •. jJ :BpIRAPPRtVAL (Restaurants) • • • • • • • • • • • • .. ❑ CONTRACTOR REGISTRATION (On File) PERNIIT FEES $3.00 per page (Scanning Fee) Miami Shores Village 4-frefiAll IX t l 4 / Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary Bond ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com $ olp 0 (s .60 x/1000 x ) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) /2O O TOTAL $ 47: CONDITION OF APPROVAL Revised July 2001 PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture Q'f Y. ;. TYPE Soakage Pit Q'i'1'. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 • • • • • • • .•• • • • • • • • • • .•• • • • • • • • • •. • • • • • • • • . •• • • •• PERMIT APPLICATION • • INSTRUCTIONS: Please indicate the tyrt of wrrlkbgir performed and quantity(ies) in the space provided below. ELECTRICAL TYPE QTY. TYP!' QTY. TVI'I•: QTV. TV,',: QTY. Minimum Fee A/C Central 1 -3 Ton A/C Central 4 -7 Ton A/C Central 8-15 Ton A/C Central 16-20 Ton A/C Central 20+ Ton A/C Window Air Conditioners Chiller Clear Violations Compactor Deep Freezer Demolition Dishwasher Dryer Fan • -- -• Fire Pump Fixture - Fluorescent Fixture Light Flood Lights FPL - Load Central Garbage Disposal Generators, etc. Heat Recovery Low -volt, Burglar Low -volt, Fire Low -volt, Intercom/Teleph. Low -volt, Television Outlet, Appliance Outlet, Wall Outlet, Switch Oven Parking Lot Lights Plugmold/Strip Posts Range/Range Top Receptacles Refrigerator, Comm. (p/PH) Refrigerator, Domestic Renew - Temp Service Repair Circuits Service, Number of Amps Service Repair Service, Temporary Signs Space Heater (kw) Spas/Hot Tubs Subfeeds, No. of Amps Swim Pool, Commercial Swim Pool, Residential Switchboards Temp Serv., Construction Temp for Test - 30 days MECHANICAL TYPE QTY. TYPE QTY. TYPE QTY. "1 YPE QTY. Minimum Fee A/C Central, Tons A/C Wall/Win. Tons Air Handler, Tons Barbecue Bath Fan - Vented, # Condensate Drain Cooling Tower Dryer Vents, Number of Ductwork, Cost of Fire Sprinkler System Fireplaces, Number of Generator Heating Strips, each Paint Booth Piping, Flammable Liquid Process/Pressure Piping Pressure Vessel Refrigeration, Tons Vent Hood, Cost Ventilation, Cost Periodic Inspections RECEIVED AND REVIEWED BY: DATE: BUILDING DEPARTMENT 10050 N.E. SECOND AVENUE MIAMI SHORES, FLORIDA 33138 -2382 TELEPHONE: (305) 795 - 2204 FAX: (305) 756 - 8972 GENERAL INFORMATION • HAVE PERMIT CARD & APPROVED PLANS ON SITE • PLEASE CALL FOR ALL INSPECTIONS AT (305)795 -2204 Leave a message in our voice ALL PERMITS REQUIRE INSPECTIONS Location of Violation COML1'ILNITY RESPONSE TEAM COMPLAINT Date/Time Received: 11\ 6 \ 0 3 By: Complaint Received Via: Telephone Self -Observation Letter Vie Complaint Other 0 4/E V .5 Nature of Violation/Compiaint p ni nr 1Ir--Q-- 144,0 a_ 10evitt — aa p if , k L d 4r. ';ei neet w Complainant's Name: L am' G 1 r 1, Complainant's Address: Complainant's Phone Number: E W: Complainant's Desires to testify: Yes No THIS AREA TO BE COMPLETED BY COMMUNITY RESPONSE TEAM ONLY Officer Name Officer Number Complaint Number Date Assigned: Logged by Case Report Number: Other Information: Violation of Code Section(s): Remarks/Comments: Recommended Action (Check all that apply): Date Close Unfounded Follow -up Needed Community Response Officer Reviewed By Miami Shores Village 10050 NE 2nd Avenue Building Permit Phone: 305- 795 -2204 Permit Number: BP2003 -224 Printed: 2/11/2003 Applicant: ENID EVELYN Owner: BURCH JOB ADDRESS: 50 Contractor Local Phone: Parcel # 1131010200030 Signed: 4 101" NE 91 BURCH ENID EVELYN ST Contractor's Address: Permit Status: APPROVED Permit Expiration: 8/10/2003 Construction Value: Work: EXTERIOR PAINTING AS PER AGREEMENT Page 1 of 1 Legal Description: EL PORTAL SEC 3 PB 9 -148 LOT 6 & W1/2 OF 5 BLK 9 LOT SIZE 75.000 X Fees: Description Amount FEE2003 -864 CCF $0.60 FEE2003 -865 Code Enforcement Fine $60.00 FEE2003 -866 Building Permit Application Fee $60.00 Total Fees: $120.60 Total Fees: $120.60 Total Receipts: $0.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servan .r employees. (INSPECTOR) BY: 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: BP2003 -224 Printed: 2/11/2003 Applicant: ENID EVELYN Owner: BURCH JOB ADDRESS: 50 Contractor Local Phone: Parcel # 1131010200030 Signed: NE 91 Building Permit BURCH ENID EVELYN ST Contractor's Address: Page 1 of 1 Fees: Description Amount FEE2003 -864 CCF $0.60 FEE2003 -865 Code Enforcement Fine $60.00 FEE2003 -866 Building Permit Application Fee $60.00 Total Fees: $120.60 Total Fees: $120.60 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 8/10/2003 Construction Value: Work: EXTERIOR PAINTING AS PER AGREEMENT Legal Description: EL PORTAL SEC 3 PB 9 -148 LOT 6 & W1/2 OF 5 BLK 9 LOT SIZE 75.000 X If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulatio pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servan o ployees. (INSPECTOR) BY: In consideration . 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2003 -224 Printed: 2/11/2003 Applicant: ENID EVELYN Owner: BURCH JOB ADDRESS: 50 Contractor Local Phone: Parcel # 1131010200030 Signed: NE 91 Building Permit BURCH ENID EVELYN ST Contractor's Address: Page 1 of 1 Fees: Description Amount FEE2003 -864 CCF $0.60 FEE2003 -865 Code Enforcement Fine $60.00 FEE2003 -866 Building Permit Application Fee $60.00 Total Fees: $120.60 Total Fees: $120.60 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 8/10/2003 Construction Value: Work: EXTERIOR PAINTING AS PER AGREEMENT Legal Description: EL PORTAL SEC 3 PB 9 -148 LOT 6 & W1/2 OF 5 BLK 9 LOT SIZE 75.000 X If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants o employees. (INSPECTOR) BY: 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: A TT_ 3 A•• • ••• • 'OWNER'S NAME - S�? 44 • • f / sw--, PHONE: 30.S- ?SF /siS f•• LAD L v J MIAMI SHARES VILLAGE PairitsCSoEer*froval and Agreement * * * * * * * * * * ** **. * * *1 *' . *•'K * * *•t * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** • • DRESS OF SI • : V E'_9 I * • at :6.y,„.: �� �.�.•, -` 3(SG3'P CONTRACTOR I: ICENS'E'(iTapplicable) COMPANY NAME: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls t akes/hoe. ('re e r) # g yg ascia Wh, D ip Cap/Drip Ede, f ti , Soy fit Gv b i' R•of Gc/ ,iP F ower Bins W , + e. hutters w h :+ e_ Awnings I� 4 Ifs v1 Orreen S it, Chimney //7A- Doors and door jams tU Garage Doors L Railings Fences iAJ /4_ Decorative Metal t, J, 11 brick (simulated or regplar) b k ; } e ucco Banding N Any other stucco features Accessory Buildings Other APPROVED: Building Official' Date PHONE: -� 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. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached samples. nature of O er Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 5 --v`' '9/ Job Address . 7) /l/ � S Tax Folio /1 3/0/ o?n / Legal Description Master Permit # Phone Contracting Co { ' 2 4 ' e 2 7 " 7 6 ( Address (g /c /0F /7 Qualifier /?1 4Ce ^e (/ 60v sl6 ( - Phone 9S Owner / Lessee / Tenant Owner's Address .LJ 4// 9/ Sr State # Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL Q ROOFING PAVING FENCE SIGN WORK DESCRIPTION APPROVED: L13r ,L 41 6 �2J ,&' f L ,97/J( sec. Municipal #D7-5/9 Competency Ins . Co . Notary as to Owner and /or Cons President My Commission Expires: NOTARY PUBLIC STATE OF FLORIDA MY COMMISSION EXP SEPT.20,1994 BONDED THRU GENERAL INS. UND. ** * * * * * * * FEES: PERMIT 3,7222 RADON Zoning Mechanical 3 2, td-ei Square Pt. Estimated Cost(value) 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 _d6‘ ‘ authorize the -named contractor to do the work stated. Sig - ure of owner and /or Condo President on Dat J/ -aS- 4 73 * C.C.F. `"- Fire Building Plumbing Signature of Contractor or er- Builder Date: .JQ .. c1 Nota as to C ont ractor or Owr}fr-Builder My Commis E xpires: NOTARY PUBLIC STATE OF FLORI MY COMM E SEPT.2 * * * ** BONDED T1RU GENEigAL INS *UND. NOTARY " TOTAL DUE � �Q Other Electrical Engineering