PAINTDate
PERMIT APPLICATION FOR MIAlt
Jab Address 320 ,)1,.) �,�tTN ��T Folic
WORK DESCRIPTIONY 'kM.:\"
Address
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State # Municipal # Competency #
Address
Address
Legal Description Historically D 17Z1 0
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Owner/Lessee / Tenants( M.C14.4 0,, Cart,
Owners Address /� Phone)LDS c:
Contracting Co49
Qualifier
Master Pennit #
Phone
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Square Ft. Estimated Cost (value) 0 _�
Ins. Co.
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circlle o e):' BUILIIDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
t.tve ae„,-
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.
OWNERS AFFIDAVIT: I certify that all the foregoing infonnation is accurate and that all w,rk will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the w ed.
r • Own -Builder D
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Notary as to Owner and/or Condo President Date No ,: as to Co S - Date
My Commission Expires: My Commissio Expires: GLADYS J VILLAIt
NCRARY PUBLIC STATE OF FLORIDA
Signature of owner and/or Condo President Date Si
FEES: PERMIT
RADON C.C.F. NOTARY
COMMICSION Nt?. CC714103
Nilt COMMISSION EXP. MAR. 1,3413?. •
BOND
APPROVED: TOTAL DUE
Zoning Building ; iltJejO Electrical
Mechanical _ Plumbing Structural Engineer