1279 NE 98 St (10)Date c . �ak Job Address �� 7 9 #i � o Tax Fo io' // J 5D g Q°2 7,1
Legal Description/41 h' / 7 °1 / - r
Owner / Lessee / Tenant eiwc S /J/ v m (?)1'1,)47 /
� � Master Permit h I �-Z,1 �
Owner's Address Aa / 9 ML - 9d p e . Phone 7.S/ - a' 7 210
Contracting Co 'ft Address
Qualifier e!l L4/ SS# - - Phone
State 4fr Municipal # Competency 4t Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): UILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING / FENCE SIGN
WORK DESCRIPTION q &, vets �� c i J? OieAe
reer7 -
s
S Ft. Estimated Cost(value) /aO
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 the work stated.
APPROVED:
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Zoning
,e
Signatu of owner and /or Condo President Signature of Contractor or Owner- Builder
Date: Date:
as to Owner and /or Condo President Notary as to Contractor or Owner- Builder
Commission Expires . NOTARY PUBLIC. STATE OF FLORIDA My Commission Expires:
NTY COMMISSION EXPIRES APRIL 16. 1992
BONDED THRU STEMBLER -ADAMS & SWEET
** * * * * * * * * * * * * * * * **
FEES: PERMIT 0 RADON C.C.F. d NOTARY . • d TOTAL DUE 4-, i fla
Fire Other
Building t4 3)19 gt., Electrical
Mechanical Plumbing Engineering