PAVERDate
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) y1
g/ Job Address 1 213 ac. `1.q. S+ree," Tax Folio 7/ f1 €25 9 6/I 4
11 ! 44 4 pi Master Permit # ' -V
Tenant v > eLke-r
Legal Description
Lessee /
Owner's Address
Contracting Co.
State# c BCD 3 0 4
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle one):
WORK DESCRIPTION
Qualifier k ( „„k
CU V �i`r lL L Cam. !v e-V
Square Ft.
-w7
CND1C C-014S`Fr.
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 re: lating cons ruction and zoning.
Furthermore; I authorize the above -named contractor to d•4 work sta
\ ih
Signature of Owner and /or Condo President
Date.:
N• ary '•s to Owner and /or Co do
* �
Commission Expires: y / 4/ 9
* *
PERMIT FEE:
SS# 7 s - Ej '14` -1 1
Competency# 30904 /1-4 Ins. Co. tic,trylciA_A I.
Address Address
Address
Address
ELECTRICAL PLUMBING MECHANICAL
President
APPROVED:
Zoning
Mechanical Plumbing
Fire
Address
Date:
Phone
Other
Electrical
Engineering
Estimated Cost *1 3 g . 0 0
ignature of Contractor or Own -, uilc:er
aiteiti;e/alleb
N aryv as to Contractor o Ow er -Bui der
My Commission Expires: LI 46 z,
* * * * * * *_ - *