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SATELLITE DISHPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) Date 8" 431 Job Address Tax � g/19 Foo1io .'�� d /© Legal Description L O J / f ��.oPK I -7 6 rnl/}S}toRgs de Permit �� 19 { f Owner / Lessee / Tenant CA RI-T 1 Amvi SSO k) Owner's Address 115 1 0I S?' Contracting Co. 31'O44wfS J4om e Pe modAddress i V 3 AJW 7 Qualifier Venn 1 6VR 1OJ SS# - - Phone 653 c a 7'7 State# C rC i4 ova J Architect /Engineer Bonding Company Mortgagor Permit Type (circle one Signature of /Owner and /or Con Date: Ncta tR Q' ner and /or EC My Commission Expires: * . * 37, -D ) 161 ALE J01 sT Competency # Ins. Co. DA-VIS eN6I IJe 3 resident * Address Address Address LECTRICAL PLUMBING WORK DESCRIPTION ATE L_L4 TE rTh • 4+ NOTARY PUBLIC STATE OF FLORIDA Y COMMISSION EXP 4 &g . INS. UND. of PERMIT FEE: APPROVED: Zoning Building 4. Mechanical Plumbing Fire *.. - . * Signature Date,, •i /J Phone MECHANICAL PAVING FENCE SIGN Square Ft. Estimated Cost y /500 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 WI 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. Contractor or Owner Bu +Mf: }ISc ATE O FLORIDA A. �/ �� .� "' {' JULY 24,7993 y as to Contractor wn�ff�BitiE'�I�Le�NS. WM. o' , ommission Expires: * * * Other Electrical Engineering