574 NE 96 St (10)WORK DESCRIPTION
PER!! CATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date • 4 .1 fr ( Job Address `5 ? S 7',24 =- 1 Tax Folio // 53-04 ) L A 6 7 E 1
Legal Description, ` 4 7
€ ner / Lessee / Tenant
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Owner's Address J'• 't NG 9 4. yr, a Phone
Contracting Co. ® Address
Qualifier SS4i - - Phone
State 1i Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor /4 o.& - 'ft' fJ 4 L - 0 Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
P^-(-5.PG e Lev c)
Square Ft. Z 7,-0° , Cost(value) / ma c
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 of owner and /or Condo President
Date:
Notary as to Owner and /or Condo President Notary as to Contractor or Owner- Builder
My Commission Expires: My Commission Expires: ���%6�r (' ''i
NOTARY PJBLIC STATE OF FLORIDA
** * * * * * * * * * * * MY CO MISSi0N XP1,4ES 4/O9/94 * **
2�q Bonded thru Stembler -Adams & Sweet PEES : PERMIT / /' RADON C.C.F. �� NOTARY Ir A TOTAL DUE ` 66
APPROVED: Fire Other
Zoning Building
4^'U /A d f (v. �v
Signatu of Go — Owner- Builder
Date JThVr/ Ina' ( 19 5�
1/7-07
Master Permit tf .5;4g8
Electrical
Mechanical Plumbing Engineering