1135 NE 99 St (3)OMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) 1�J L
/ Job Address qa 69 sceoi e, g u Gl . Tax Folio // W, /9.
7e wigzfar Master Permit # 45 V
G iGo \e- C a oc - ,re j
Y4 bt 2 Phone
Date g
Legal Description /3
/ Lessee / Tenant
Owner's Address
Contracting Co. e..‘,_
Qualifier \ e Co ok
State# C & 63890 4
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle one):
WORK DESCRIPTION �°h Gl OS Cam. -1 G_D o (Z Q rr k G e r,K , ►ti ol/� 5 , Lc
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' � o r [A ► V�►e � Sited P_)c`121r ('DVS boct r
Square Ft. Estimated Cost ) 00,(11.9.-
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 7- work s -'ed.
Sig.
Date:
c
ture of Owner
d/
Mechanical
Competency# 3.53 04
Address
Address
Address
ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
ondo President
. /
_/ /;i i di.' /ii
Nata ' as -o Owner and /or Condo President
My ( Isis i on Expires:
* . * * * * *
PERMIT FEE: APPROVED:
Zoning
*
Fire
Address
SS# 2.Z.._ -(1 -SS S Phone - 15 - e 44
Ins. Co. 1 14r , ac-,.SI .
- 74 ,).E 114. 5 +.
S'gnature of Contractor or Owner - Builder
ate: //
�c� (% 6)
Not a to Contracto ,9 can
My ommission Expires: '1//t(
y / er- Builder
*
2 -5 /Q Electrical
* * *
Other
Engineering
*
t a o i ° � 1 p vet -
,'rr. ),-,5-16 .
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