760 NE 96 St (3)Date
Legs_ .
Owner
4TION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
., c S7 ' 2 I i� 2 ' / 2
, � (�; � Tax Folio 1)
:14-"6 44, - & Master Permit #
'.enant , ote'-e! \ �(?_ lvl us()
Owner's Address
Contracting Co. ►L',' Y i e � Address
Qualifier
State# Competency# Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft.
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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
ermits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work.
WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
ill be done in compliance with all applicable laws regulating construction and zoning.
urthermore, I authorize the above -named contractor to do the work stated.
ignature of Owner and /or Condo Prudent
ate:
of -� y to Owner and / $resident
y commission Expires:``��jj /f
ERMIT FEE: APPROVED:
*
Fire
Zoning Building
'YMechanical
Plumbing
Estimated Cost t
Phone I ( - 1C; 9 ( -)
SS# - - Phone
Signature of Contractor or Owner- Builder
Date:
Notary as to Contractor or Owner- Builder
My Commission Expires:
* * *
Other
Electrical
Engineering
* . *`` *
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