930 NE 95 St (3)/ d 4 ERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date '7 °19: Job Address 7 / 77 Y 9.5 Tax Folio /11.
i I Z 25 ® 7 0.
Legal Description 9 /t//a? g S Gl/ 900 i P 02ge
✓Owner / e / s__4?"p ,/E;E',". fir' Master Permit #,V3
Owner's Address ...-----
Phone 7,57— /9/1'
Contracting Co. Address
�ualifier eTA /(/',/ SS# - - Phone
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGt
WORK DESCRIPTION ( e _.e;Lh)
Square Ft. Estimated Cost(value) - , fJ D
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENI
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUf
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. I understand that separatf
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 wil:
be done in compliance with all applicable laws regulating construction and zoning. Furthermore,
authorize the above -named contractor to do the work stated.
Signature of owner and /or Condo President Signatu a o' actor or Owner- Builder
;/ /e) Date: Date' . y�9�
APPROVED: Fire
Mechanical Plumbing
!/21444i. ` J
Other
Notary as to Owner and /or Condo President Notary as to Contractor or Owner- Builder
My Commission Expires: My Commission Expi !/ Z an � �- 6 1�'
NOTARY PUBLIC res: STATE e OF FLO
MY COMMISSION EXPIRES /09/94 * **
** * * * * * * * * * * * Bonded lbw Steller - Adams & S et
FEES: PERMIT '7' S�� RADON C.C.F. , NOTARY TOTAL DUE 43• ° 0
Zoning :uildin!_,/ '/ 41- "Electrical
Engineering