1190 NE 100 St (9)(OWNER TO RETAIN COPY) �J
Date 6? � ,(Job Address // ) /0 Tax Folio g VDS 7v Q '
Legal Description / 6,11/ �� 9 ha Master Permit # .1,
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
/ Lessee / Tenant A L 040 E < Of■I R e_o0Sk`.
Owner's Address 1 (9 0 t 1 d 0 S fi Phone 5 Po?
Contracting Co. Address
Qualifier O . SS# - - Phone
State# Competency #
Architect /Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
PERMIT FEE: APPROVED:
oning
Mechanical
WORK DESCRIPTION
1?,0 eA0A:
Square Ft. Estimated Cost oq
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.
Furthermore, I authorize the above -named contractor to do the work stated.
Signature 07 Owner and /or Condo President Signature of Contractor or Owner - Builder
Date:
AO F.-Lei
N•fary /asto Owner and /or and President Notary as to Contractor or Owner - Builder
My Commission Expires: / 7 My Commission Expires:
*
Fire
Building
Plumbing
Address
Address
Address
Date:
Ins. Co.
Other
Electrical
Engineering
c