1074 NE 99 StPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
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Job Address
Legal Description
Owne / Lessee / Tenant
Owner's.Address
Contracting Co.
Qualifier.r /%
State# °°‘
Architect /Engineer
—^� 67 y��, 97 hone
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Address
Address
Bonding Company Address
Mortgagor Address
Master Permit # , ` , O?c y
SS4hOZ ' phone ��3 - %I m / .
Competency # Ins . Co . 7/19vgrdE..cf—
Permit Type (circle one): ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION 3 C5J E 7 pct s //;e:/ EivJ' 7 J6 G . J/ C J '
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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. 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 a named contractor to do the work stated.
�C .D L C4' `F3o 37K ' -� / - 6(P.
ignatu 'f of Owner and /or Condo President
Date:oZ - -' i /
Notary as to Owner and /or Condo President
My Commission Expires :NOTARY PUBLIC, STATE OF FLO A.
O
BONDED � THRUU NOTARY PUBLIC UNDER UTUS.
PERMIT FEE: APPROVED: Fire
Zoning Building
Mechanical
Plumbing
Signature C6ntracr or�BiIS °FY�f"��om�
Date:
N� of rs 9,.� � toO t A � (7L e-*
?Vi o� S!'fic
aONDD 'E-LU .:=: Erty., MS. MID.
Notary as to Contractor or OwrieniBu
My Commission Expires:
* * *
Other
Electrical
Engineering
7.17) NOT octh.