FUMIGATIONPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
Job Address
Legal Description g P - 73KordimmaTJpag li: v--
C CO(
r� m � _ f
Owner's Address Sel `-- •
-( I ?Es7 \cofro, Address
Qualifier Sy IUN DIY 4 DV V SS# phone J ` — vv
Owner / Lessee / Tenant
Contracting Co.
State #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
Sig
Dat
96D NE qq S1�
Zoning
(OWNER TO RETAIN COPY)
Competency# Ins. Co.
Turni6oiriow
OWNER'S AFFIDAVIT: I certify that all the foregoing informat
will be done in compliance with all applicable laws re
Furthermore, I authorize the above -named contractor to d
l o
' ■ ' , AV .L %LI
o' Owner and /or Condo President
1,f 12 -12
Nota y as to Owner and /or Condo President
My Commission. Expires: T1b
* * * * VOTARY S$ IC
MY CGIMT EEI NE.101 10.
PERMIT FEE: APPROVEDMUM Fire
Mechanical Plumbing
// 5e1 aIi7U'
,9,1 Master Permit # A��¢ •
S
Date:
Tax
Folio
phone
Square Ft. 2C l QQ V C-0 Estimated Cost <699
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. 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.
My Commission Expires:
�c # * *
accurate and that all work
t,i construction and zoning.
ork stated.
Contractor or Owner - Builder
Notar as to Contractor or Owner - Builder
Other
ROTARY 1 STATE OF %ORION
NY CM/MISSION VIP R. JW.1915
BONDED T Rtf SEIERAL II . tN g.
Engineering
12-1z-g)
Building
Electrical