PAINTBianca 30A - 3P
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escription
� 1 2/ Q I
Lessee / Tenant 4/) an_ 1 � �hI 1 (� 5 Master Permit # SJ(o I `I
r s Address ?6 /° 7 Phone :75 l -0 6' 0 1
Contracting Co. d ) W . Address WOfk 320 -6163„
Qualifier SS# - -
State # Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION a ( 14 i / bokse , p` G 6 C(}aW 5- •
Square Ft. Estimated Cost(value)
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 wit all applicable laws regulating construction and zoning. Furthermore, I
authori e the above -na . c ntrac,.r to do the work stated.
VIIIIT AIFINLIIECA1f1 ON IF IR MIIAIM I SIIII ®RIES VIIILILAGE
Address
X11/
gnature :''owner and /or Condo President
Date:
Tax Folio
Phone
Signature of Contractor or Owner - Builder
Date:
Notar as to Owne+c/and / Condo President Notary as to Contractor or Owner - Builder
My Commission Expires:
a'•"••"o. Nul An: it 10 FLADA
VEP NVfit: ": r''
My Commission Expires:
NY C ON ti tz tr tr tr tr o o tz
Zoning Buildin
C.C.F. a NOTARY TOTAL DUE V
Fire
Mechanical Plumbink
Other
Electrical
Engineering
PERMIT APPLICK'D
Date 3 /Z/ JobAddress x -?' / Air
Legal Description -�I
Owner/Lessee / Tenant}( u. p d /AJU14 r4
Owner's Address /
Contracting Co. V S (f 1
Qualifier SS#
State # Municipal # Competency #
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL
Signature of owner and/or Condo President Date
Notary as to Owner and/or Condo President Date
My Commission Expires:
FEES: PERMIT
RADON
APPROVED:
Zoning Building
Mechanical Plumbing
Address
Address
Phon
Electrical
Phone
Ins. Co.
Square Ft. Estimated Cost (valu 5 O
er- Builder
Yellow X
No
C.C.F. ° 6 D NOTARY', BOND
TOTAL DUE WO 6d
LO
SW 166h
OWING 'PATIO FENCE SIGN
WARNIING TO OWNER: YOU MUST RECORD A NOTIICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR ¶I 'ROVEMENTS TO YOUR PROPERTY (I F YOU INTEND TO OBTAIN 'FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY I; EFORE 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. /,c/4-
1
Signature of Contractor or
difitMLItHIMINOZW
y Com ssirin,Bxpi KER
x.
NOTARY PUBLIC C STATE OF
COMMISSION NO. CC4723
MY COM SSION E 14 IMO
11
o
3/
Date
Structural Engineer
.1.1