989 NE 95 St (5)PERMIT APPLICATION FOR MI,
Date 7 ) -2.1 - 00 Job Address x ci 1V - E I S Itrabt T ax
Legal Description 1 � )S( L(� Historical
S Nes `av-, �t 1
Owner/Lessee / Tenant
989 1\1 -E s�
Owner's Address X Phone
Contracting Co. 6Ls742r7 f/$i �4 / %7
Qualifier 9P 71 sy SS# f8 - 368r Phone 3c' 607 52
State # / Municipal # Competency # 9f' /3S003Z1 Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft. Estimated Cost (value), ,245
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
— coastiagcticaand '' _ F ennore, I authorize the above -named contractor to do the work sta
Signature of owner and/or
Notary as to Own
My Commissi )n,
0
2
FEES: PERMIT
..--):26r
do President Date
OFRCIAL NOTARY SEAL
� e�i S MARGARITA MONTIEL
;r 0 OO#!SSION NUMBER
c CC797277
oFFCO D1v ® c CC 1 N , 00 ES
RADON
APPROVED:
Zoning Building
Mechanical
sh Gf�/T,4
3 -2
Date
, f
S
C.C.F. NOTARY
N67ie4e (%'.
filoc
465-3
3° 5l i 9 .-z.qs
Address 56S le 'ee- --
e'of Contractor or Owner - Builder
h 76020 6 Y0ti' -lbf
3 -2
otary as to Contractor or Owner - Builder
y Commission xpiresoOFFl -R.
GLADNS J NII.IAR EA
NOTARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC714to3
MY COMM ISSHo , EXP.M.s , 1,7032
Electrical
BOND
TOTAL DUE
1 /B
J.2 c
Date
Plumbing Structural Engineer
668
0