1201 NE 102 St (9)Date Job Address MO/ N/ /O2 5 Z
Legal Description L0 4/ i N4 4`ee2 See. /i4m/ 54/`es
Owner / Lessee / Tenant t 6V1 4. (i5
Owner's Address L25/ /VL /az SA Phone Z1 b7S '
Contracting Co. Kei42, Je uti - y 5yS4 -em Address J8,3t (.&, dileAlti Ai
Qualifier 60'r /,7JSAt.(.c el" SS# / Phone '/A 7 7 O
State #)5F0ZO697SMunicipal # Competency # /f7f Ve'Ins.Co.
Architect /Engineer /S/ii Address
Bonding Company / Address
Mortgagor /[//`'y address
Permit Type(circle one): BUILDING
" fL / ECTRICA /f LUMBING MECHANICAL ROOFING PAVING FENCE SIGI
WORK DESCRIPTION - 1— `I.STR`1 ��J' ✓ /4f 1/4/4
/ C' o�r / f ? Pi
Square Ft. Estimated Cost(value)
TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DC
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTENI
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUI
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, an
on the attached addendum (if applicable). I certify that all work will be performed to meet th
standards of all laws regulating construction in this jurisdiction. I understand that separat;
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 wil .
be done in compliance with all applicable laws regulating construction and zoning. Furthermore,
authorize g above -named contractor to do the work stated.
and /or Condo President
;Signature of owner
Date:
MALL ,
•.- r as to
P,: PROVED:
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY) pi Sh9�e�5
er
i
P t se • a e . 'oar u.l • al I 9 y
Y
Personally known ❑OR Produced I.1R
Type and number of I.D produced:
** 41 .1{r* i (`..*
❑ DID take an oath, or
oath. ,3.96 RADON C.C.F. ) ' 45
Zoning
President
* * *
Mechanical
* *
Tax Folio // 3aasoas /6c'
Master Permit #
gnature of Co ractor or Owner- Builder
Date: V ' 3 ya
No y as to
Commissio
*
*
AL"
Conrrac��t EOriLO% he - lder
Rif �Suc STATE OF FLOR A
CO IV I CC206455
COMMIISSION EOP. UNE 9,199
MY COMMISSION
*
NOTARY
*
Plumbing Engineering
*
3342/
*
TOTAL DUE ,°4
**
Fire Other
Building Electrical M 1) �' \ 1, Q l,�Q�'