PAINTPERMIT APPLICATION FOR MUNICIPALITIES OF DADE
(OWNER TO RETAIN COPY)
Job Address ✓,Z 7` 5 /04e j>,? 5 574- Tax Folio l ®�
__,, // _ / / °Buff TWT SW2340
Legal Description r Icss tJe t�Z.f t � pr� 4 7 43 /ae,C zXR F
�. ?,cl
/ Lessee / Tenant
Owner's Address
.5;5;5' IV a e,5 41)-r 4 .s O tee/ #hone6K07) 7,32 - CaXD�
Contracting Co. 2 iiTl ' Je),y6.
Addre ss , — S � 9 Qualifier (AP/ ✓ •.C•10 SS# - - Phone6 es 70c,Z-S 6
State # Municipal 4' Competency #f Ze' 5° 1S s .Co.
Architect /Engineer / / Address
Bonding Company
Mortgagor
Address
Permit Type(circle ono): BUILD ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
WORK DESCRIPTION (6t PC3c.L t :--4-43/e12 ��te�2 ��d P4
e
Square Ft. e,'e cP
APPROVED:
Notary as to Owner and;or o resident
� ��,
My Commission EeE; —L.: nl∎a �,,
=fit. T=,> ^ter r7 c3a r.
Fire
Building
Mechanical Plumbing_
Zoning
Master Permit #
Address
Estimated Cost(value)Z an
6
•
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 •mpl' nce with all applicable laws regulating consty ction and zoning. Furthermore, I
authorize 'h= ye-nn med contractor to do the work stated.
Signature of o-'er andor Condo President , Signature o Contra for o wner -Builder
Date 3/4/9,2 - .. - -_ -, ti ! 4 : 5 �� 4 Date: 3
Notary as to Contractor oar- Builder
My Commission`Exfir ' whirr 3 n.
? .F' ZIDNI`i''E1 a
** * * * * * * * * * * * * * * * *
FEES: PERMIT ( 1 5 l RADON C.C.F. ) NOTARY TOTAL DUE '1t lf
14)92/
Other
Electrical
Engineering