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759 NE 94 St (6)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date W Job Address 7S 7 //f S Tax Folio 1/ AJIJ /1 .2 e'4' J/ Legal Description oricV/V-Ay 1p 7 ‘70 Master Permit # his SCO/64 Owner / Lessee / Tenant Owner's Address 7 S9 /V6 96 L-/ / c4- Phone Contracting Co. � enPj &Dune!! ' ' epic Address /g(9(/ /U, 6a„ p9 9 A e. At j 0 State ° g& - ` 7 J 7) Architect /Engineer `— Qualifier Bonding Company Mortgagor 3ignat Jate: Jo Commies 'ERMIT FEE 36 i� to Owner anAxiff gta�E tat Large ion ExpireseMy Commission Expires Jan. 21, 1992 . * ifonded thrt*kgent's N*tary Brokerage APPROVED: and /or Condo President Zoning Mechanical SS # / PhoneCvOS) bbl - g°9 Competency# CG /7&Os Address Address Address Fire Building 9 Ins. Co. 1 7"ri. 7 Faze Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION 4 ro i n 1' e /d ,57S- 6/(0 4 /(3'r) Square Ft. Estimated Cost ` 471 966 66 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 uermits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work. ?WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work ,ill be done in compliance with all applicable 1 ws regulating construction and zoning. Furthermore, I authorize the above -named contract to do the work stated. ar as to Contractojotegy entheast ioldeyida at Large My Commission Expires: My Commission Expires Jan. 21, 1992 7k * yt *Bonded tau Agent'*Notary Brokerage Other Electrical Engineering or or Owner- Builder 4 l p Permit Application Number ----------- -- ------ --- ---- -- -PART I - APPLICATION ------------------------------------ ----- ---- -- Date of Application Name of Owner Mailing Address of Owner ! S Pif 1 O ✓) , Owner's Agent i~Jv ;Jr- ��,.� Co a1 , �A • , V .. / Builder Property Street Address '1 Lot No. Btock No Subdivision Date Subdivided NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION Agent's Mailing Address This Application is for: New System Repair Type of No. Bedrooms Heated or Cooled Area No. Dwelling Sewage Flow Residential (each dwelling unit) (each dwelling unit) Units (Gallons per day) s cie STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Exact Directions to Property Type of Establishment fr S6,o1 ( TOTAL FLOW = 3 HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-001- 4015 -1) Authority Chapter 381, FS Chapter 10D -6, FAC Telephone Number 40 e-/ Telephone No. (.2.i EiC5 Sewage Flow Sewage Flow (Gallons per day) Based On ft ft Existing System AUDIT CONTROL NO Applicant's Signature Page 1 of 3 , STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT •aa.ruaaa!!a aw• a• laa aaalaaa... . a ....l.a.!!!' ..nnonlot 1. /m.r.a U...■. •i! ■•wolsis ■ ta ! ■s!o• ■wo ■wr•io■■!i■w# w# ■ i■i■!• i!! t#!$■■■/ ■!!!#!■■i!■■■■■■r wows ■••r•■• • ■•■ r■/■ wo!•• o• ii!!! 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Site Plan Submitted by: HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 002 - 4015 -6) PART II - SITE PLAN Permit Application Number Avross iQ T ,,clos URE Not Approved ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Plan Approved By County Public Unit Date Page 2 of 3