1041 NE 96 St (6)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Datev) 0 // ' �` Job Address /1 )10L951
%" L 9 �JJ Tax Folio(/ 0 l/� ,
Legal Description iL t3.- / O - (7M 4Ai
Owner / Lessee / Tenant cJbh.n 1- Z, t'7-( Master Permit #-% - . 16-1/
Owner's Address /U/ / Pi. C 1 6 S % Phone 7X/-1
Contracting Co. Address
Qualifier 0,4/ A/AT e SS# - - Phone
State fP Municipal t Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING PENCE SIGN
ORK DESCRIPTION /4'1r
Square Ft. Estimated Cost(value) '5'6 O. 60
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.
Signs ure of owner and /or Condo President Signature of Contractor or Owner- Builder
Dater Date:
,.. i 2 ,rme A
'
No ry to Owner and /��A p d no
My Commission Expire ""�IC,A 0 FLpI�It�r
� 'JY COMMISSION EXPIRES APRIL 16, 1992
BONDED DM STRIKER-ADAMS & SWEET
Notary as to Contractor or Owner- Builder
My Commission Expires:
** * * * * * * * * * * * * * * * *
FEES: PERMIT 3 S RADON C.C.F. 5 NOTARY ° �� TOTAL DUE 4 7
APPROVED:
Fire / Other
`d/
Zoning Building ,/(9M
Mechanical Plumbing Engineering
Electrical