1249 NE 100 St (12)(OWNER TO RETAIN COPY) n
Job Address /,2 p' /, /` 7 c � Tax Folio 1/ J.26 �0 b !/ o 6
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Legal Description kg/ .45 7 4/(00 t / / u - Master Permit # ,3;/1
Owner / Lessee / Tenant 14U,415 /2, 4 7 'f ✓2.
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
Qualifier SS# - - phone
State# Competency# Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Date:
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C , 5 (60
Zoning Building
Mechanical
Date:
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Owner' Address /G ! /u, / lJ U �� S7 phone 75% 4// R/
Contracting Co. Q w /U.0 Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENC t SIGN
WORK DESCRIPTION / 5 p c L( 99, � /off ��E� It VAY)c-
Square Ft. % Estimated Cost rn p
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.
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 of Owner and /or Condo President Signature of Contractor or Owner - Builder
Ain, &.1./lait/
y s to Owner and /or Condo President Notary as to Contractor or Owner - Builder
M9'Commission Expires: NOTARY PUBLIC. STATE OF FLORIDA My Commission Expires:
f COMMISkdON EXPIRikS APRIL 1* 1992 * * * * *
BONDED THRU STEMBLER -ADAMS & ,SWEET
PERMIT FEE: APPROVED: Fire Other
Electrical
Plumbing Engineering