1266 NE 101 St (3)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
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Date ' r 04 0. 6 i / Job Address) 7' 101 o3�� . Tax Folio 2 °'�
Legal Description Master Permit # J /
Owner / Lessee / Tenant
Owner's Address 12 f ' ( 0 ( 0 L C . 1 0 1 WtOdlrYli S ho- J ��
Contracting Co. °Au I bAAALicur Address 17. (0 U2 E 1 0 . E S 1 ,
Qualifier SS# - - Phone
State# Competency# Ins. Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION RQ,D)cLcInGC C/�ll.l5 hY- J Gl1l�t�w l ' COE C_L4(i/f4 ricifno m W I
Munry) ► ( d a bo n\ oc uJ wl riiA):-.) — No .- 1- C {'h (A/ 1 1
Square Ft. Estimated Cost 11) 4,1 fl00, 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.
Furthermore, I authorize the above -named contractor to do the work stated.
/12dcb,_;
Signature of Owner and /or Condo President Signatur of Contra o Owner- Builder
Date: 6.'C/9 n
Notary as to Owner and /or Condo President
My Commission Expires:
* . * * * * *
PERMIT FEE: APPROVED:
tdo
Zoning Building
Mechanical Plumbing
T *orate C;<<(V7
*
Fire
Notary as to Contractor or Owner - Builder
My Commission Expires:NOTARY PUBLIC STATr F FLORIC
* * * �41Y COfdMI 51011 EXPIRTS 5/09/9
Other Bonded tbru Stembler -Adams & best
44
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Phone
Electrical
Engineering
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