160 NE 102 St (7)Date 3 - 3) - 9 a Job Address /(,00 NE 16 a eSi'
Legal Description
Owner / Lessee / Tenant rx A e e 4. A
Owner's Address / (p o» / 0 a S p e
Contractingg Co . E rn t / e y /l�eTu i? A k
Qualifier Ro�e�2f" S• Keir
PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Notary as to Owner and /or Condo President
My Commission Expires:
Tax Folio // 0,206 .12 /4 t9
Airs. Sec, /AV
Master Permit # .J Z g
Phone( 7 - 9s' Lip /
Sts._. A14 l%
Address la Co So NtcJ Sy - . Sti/e /0 3 3 3 32S
Phone /3 os) 8 / P -00s.0
State # Municipal # Competency #E F0000 / Ins .Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION A i l M1- ARm
Square Pt. Estimated Cost(value) °° o` 95.06
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 pnd /hat all work will
be done in compliance with all applicable laws regulating co s ct'•n g. Furthermore, I
authorize the above -named contractor to do the work stated.
Signat re��isof owner and /or Condo President
Date I��' �9�. SrAYZ OF FLORIDA.
tienu:;c� - �at:�ro;r 4 :�;a� ;
Signature of Contractor or Owner- Builder
Date:
Notary a
My Co
to Contractor or Owner - Builder
sio C.F0 S ?.'1V? 09:
MY COMMISSION ESIt %!4C.S: i.1i.e:. 9.;. 1
®ONOCB 40o2M 004ACQV
** * * * * * * * * * * * * * * * **
FEES: PERMIT "' RADON C.C.F. NOTARY TOTAL DUE 3000
APPROVED: Fire Other
Zoning Building Electrical 1 0 j3 " 11)3
Mechanical Plumbing Engineering