5 NE 99 St (2)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO R COPY) gg
Date 1' 1aa Job Address 5 E, c1 q l� • Tax Folio I -g gre 3 I O
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Legal Description ., 1 P b d. CU.,O,(` ,kg Master Permit # \J
Owner / Lessee / Tenant MJ... N)
Owner's Address 5 .
Contracting Co.C Q Address 1-�- ' l St3 - I 5 cwQ
Qualifier
State# r Ec -
Architect /Engineer
Bonding Company Address
Sig
Dat
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SS # # Phone Q( OeS''''
Competency# t /e Ins. Co. . A)/3.Q
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION `Dv.Ja_QQ,
Square Ft. Estimated Cost \ 100.00
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.
Furtl rmore, I t horize the above -named contractor to do..the work stated. OO
atute Ef N mud to
ll�li
ondo President
. _ • • •
•
Mechanical
2
Notary °ak. .owner an �to tibpfi hiic811�sQi
My Commiss��,p(r � pvitt y`Commission Expires Oct. 17, 1992
* • * ..��;.'`'* 8ondedifhru Banke* his. Co. *
PERMIT FEE: APPROVED: Fire
Zoning Building
�°►' ' , k-NL0 ' C .ham
Plumbing
Signature
Date: '++ •
Notary as Vpn
My CommissAgr�
�Ir * �
Phone ""1 — y 9,5
NOIWAY
LIPZ
Electrical
Engineering
- Builder
119t8t� RErid
tnmission Expires Oct. 17, 1992
Bon ` I fhru rnke Ins. CO.
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Note: Underground encroachments and"-- / l s. L
utilities if any, not located. f4YEM,vT
(c). con:;puied MM) = measu/ e d 1. ov i. fe ciwinete/
P_/W = ruhf of -aly aafx a C
FLOOD ZONE: X
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Certified To: M And M Title Services,
Inc. and J.I. Kislak Mortgage Service
Corporation, its successors and /or assigns,
and /or the Secretary of Housing and Urban
Development, Washington, D.C., his
successors and assigns in office, as their
interests may appear -and Commonwealth Land
Tltlek Il mac A spiglatn o ON MERIDIAN.
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(hLE PLANS ARE APP.;0\ E,) r
.....:U.,.::.E ',.: ; Fi iiiLDING PERMIT
.E") i'STED IN "REMARKS"
:7. ..:';-!...: S' :7.!jP.OING AND ZONING
... ....'!1';11:.Y LISTED BELOW.
1 .'i .:1 li....S MOST EE COMPLIED
!..f ,.. ' : ! :' thte
• WITH I`'0 rr'!!•.." 1.1 '.
NO OTHER DE rlT .' FR9',"; .:
ORDAl\r'ES
AL OTrER ..'-' I.:- '3'.E Si:,TE
:;! BY AL P.ART;ES.
! DEP:.;;Ii.iErii
PI3 ViCS
POLE DEP;
BUILDING 0121::: • :
An
PLAN::1;:G & Z!..);..."..1 .'...
VILLAGE COU,;..:V., ...
APPROVAL
PRELIMINARY: FINAL:
REMARKS:
COMPLIANCE WITH T1 ,:siUT
BY 1111011 SHORES . 1.11.11•GE ;S I;EI)U:::.
SUB CONTRACTOR3 .',:' :. - .-"...
i ING REGULATIONS WHETHER OR
Fll.:"-. i-..::' f)! •:;.] - :(1...E AS- ':?To i
1 ARD;liE.T. PUV.DER 3
• '-
NOT SPECIFICALLY INDICATED HEREIN.
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