PAINTNotary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT 50 RADON
APPROVED:
Zoning Building
Mechanical Plumbing
ritt(e0
Address
PERMIT APPLICATION FOk . NIL
Date 8 ^ 241 Job Address /0 3(0 gsn sr . Tax Folio
O/Z
Legal Description I Historically Designated: Yes
Owner/Lessee / Tenant T ` AI N l . D t 6 U L- 2 Master Permit #
Owner's Address 10 3G. A) E g57.1t ST
Contracting Co. - T- 9 N e--- Address
Qualifier SS#
State # Municipal # Competency #
Architect/Engineer Address
Bonding Company
Mortgagor Address
Phone 3 D S
Phone
Ins. Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL OOFING PAVING FENCE SIGN
WORK DESCRIPTION NT �
rErao � / / OF AA-C
17 gU* , m eIe!m , wi wQ-
Square Ft. SAS oZ D ddb -ao Estimated Cost (value) 2 ' S0 o ,
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 contractor to do the work stated.
g'-2
Signature of owner and/or Condo President Date ignature o tractor or Own uilder e
145.2-6 -go/- y���� -6 °/
g 9- ov
No .. as to Contractor or Owner - Builder
My Commission Expires: ()Per NOT
CLADYS J VIL1AR
"I &t3Y PUBLIC STATE OF FLORIDA
COMMISSION NO. CCI14103
MY COMMISSION EXP. MAR. 1 .C3?.
C.C.F. c2 NOTARY c BOND
Electrical
TOTAL DUE
0
Structural Engineer