1238 NE 96 St (6)PERMIT APPLICATION FOR MUNICIPALITIES
(OWNER TO RETAIN COPY)
Date 401W W Job Address Aegilr � ' f665 Tax
Legal Description J, / '/1 mac i Master
Pik, Alfot .0e64- gAitivei
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nhg,fatf q4 1 4k / e /
Owner / Lessee / Tenant
Owner's Address
Contracting Co. Address
Qualifier
State #
Architect /Engineer
Bonding Company
Mortgagor
PERMIT FEE: APPROVED:
Zoning
Mechanical
x em Il f -
toprie
Competency #
N Z A.
SS#
No ry a to Owner and /or Co do President
My Commission Expires:
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*
Fire
Building
Plumbing
Address
Address
Address
4-*
Folio /) 3,1 04/3g�Ay
Permit # 3/ y,z
Phone
Phone
OF DADE COUNTY
Ins. Co.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION `4/ j440/2., ,404 e 4X pA* ir 0ui9/Of J4IL
/,dam /*// J r p 5 J%56' L A & ar — A.
Square Ft._1
Estimated Cost /,o0
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.
Signature cf •wrier and /or Condo P ident Signature of Contractor or Owner - Builder
Date:- "- Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
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Other
Electrical
Engineering