304 NE 99 St (13)Date `OR'
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address N.F. Q JT YsK
Legal Description Miam; L5knn°s - .SCC• / I J ob P8
Owner / Lessee / Tenant Cl rir//7/ o. fb/Yrr r
Owner's Address .Yy lvf q9,,
Contracting Co. (l rCle 5 curi-h1 _`ipkrrl
Qualifier PPM 3('f' H:r
State /Pf F(X'Y$2t Municipal PP Competency 4P Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL 3LUMBING MECHANICAL ROOFING PAVING FENCE SIGs
My Commission E
FEES: PERMIT
APPROVED:
Zoning
WORK DESCRIPTION Our91Qr" Et (--7T/ COL
1- 1 403 . 1er / pnhrrr3-
Notary as to : �
�`' COMMISSION NUMBER
'J' °''" o CC255237
'' OF Pt.O MY COMMISSION EXP.
JAN. 26 1997
** *
r k, RADON C.C.F. ) / "
Mechanical
tht 1 ('4 !2 5 /
Master Permit #
Phone 5 - y
Address 1 73`ll) . ) (0/ 00
Tax Folio
// 3,2 /3 -Soo6
Phone "0
Square Pt. Estimated Cost(value) r'�9Q0-00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENI
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUI
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. I understand that separat
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 wil .
be done in compliance with all applicable laws regulating construction and zoning. Furthermore, -
authorize the above-named contractor to do the work stated.
a.vk A vg. ViSLAAC 1 64hijhrirker.
Signature o owner and /or CoodagOmmeant Signature of on tra° o• or Owner- Builder
Date: Date:
Plumbing
•
Not a:' to •ntr tor o Cwnar- Builder
My Co. sio Expires: zei a y
NOTARY PUBLIC STATE
NY COlrIMM ON FJIp.00P. 22,1995
* * 80NIitED1tRU , ERAL 15.UNU * , � **
�,
NOTARY TOTAL DUE \"'
Fire Other
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Building Electrical 7 . j.jw?-p
Engineering