1140 NE 100 St (15)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) CSI V 1 St-k-D2C5
Date Z - x'9 3 Job Address / / '/O /V / ®d Ste' Tax Folio 1/ -.32c � -
Legal Description 7 / / &q1
Owner / Lessee / Tenant 7% // {9 / -er,,1 Master Permit 4k(
Owner's Address I 0 A &A 11 L) NE IC 5 . 56re5 FL Phone (300 %S( -
r
Contracting Co. Soc cos + ' eGV r / r� 4 Address 77.F,,f ,Q✓
Qualifier yp�S1 // // S S# Phone VG)7- ti 5'o c
State 0 ici 0 Competency 0 Ins .Co
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 1,7,-.74t UST r /9//9e g7
/ - G' 5 TGr //
Square Ft. Estimated Cost(value) 77j.
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 -a� applicable laws regulating construction and zoning. Furthermore, I
authorize he :ve Amed ,S6ntracter to do the work stated.
Signatur of o4ner d / -
Date:
Notary as to • ' er `` �� ad� A r Condo P e4s� 5ei1"
My Commission .�
y Expo . s I& '�: ,:� Robert C. Beggs
,N: " "" `a= My Commission Expires 515196
✓INN, Y
%,r� O hui�``O e or � Commission #CC 198908
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*
FEES: PERMIT 3 ,O r d RADON C.C.F. 5 NOTARY TOTAL DUE 3 So
APPROVED:
Fire
Zoning Buildin
Mechanical Plumbing
Signature o'f Contractor or Owner- Builder
Date:
Notary as to ('ftractor or Owner- Builder
My Commission E404 "OFFICIAL SEAL"
rik
*- Robert C. Beggs
'o My Commission Expires 515/96
* 11 {;: F v0 Corimission ICC 1989
, � O F �
Other
Electrical
Engineerin