PAINTPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address g36 G Q3 . Tax Folio /J 3206 / 3 6'605
Legal Description o /ba 6 1/k 4Ti iitd,p/V. ///S. '1Iaster Pe rit e
Owner / Lessee / Tenant Patti !. Ve1b06GL-
Owner's Address 335 'VLF sq phone i Z TO
Contracting Co. -- (j',4O A2J Address
Qualifier SS# - - phone
State# Competency# Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
L+ Re<xr,L Whi ke. - Tr; vY1
Square Ft. Estimated Cost LIDO. OD
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. 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 of Owner and /or Condo President
Dat
Girt
n PQA (14
Notary as to Owner and /or Condo President
My Commission Expires: NOTARY PUBLIC. STATE OF FLORIDA.
* *
1•B OIJD y MY COirltrl°�,5, ION EXPI1V: MAR. 6. *093.
ED THAI, NOTARY PUBLIC UNDERWRITERS.
PERMIT FEE: APPROVED:
Zoning
Mechanical
Fire
Madsen
tc� E.rI
41 /L1 i4 . )/43941.0
. Signature of Contractor or Owner - Builder
Date:
Notary as to Contractor or Owner - Builder
My Commission Expires: N otARy PUBLIC. STATgg�OF FLORig(�A�.
*1Y COMiMI ON EXPIR*: MAR. 6.1'993.
Other
Electrical
Plumbing Engineering
BONDED TNRU NOTARY PUBLIC UNDERWRITERS.