434 NE 102 St (8)Mortgagor
Permit Type(circle one
WORK DESCRIPTION
** * * *
FEES: PERMIT SPi a
APPROVED:
PERMIT APPLICATION FOR MitalICIPALITIES OF
(OWNER TO RETAIN COPY)
Job Address 1 /flE / f
Legal Description/lip /' 2' t� !��,` ✓4
Owner / Lessee / Tenant . rON 4,
Owner's Address " 7` lil/_� /0. 5 7‘ -. 7
Contracting Co. ../4 4 AO'' Address v 9 AZ / `
Qualifier D X SSI 373- d -L -/M Phone �i 7 `=
State itn90 icipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Square Ft. Estimated Cost(value)
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 i ccurate and that all work will
be done in compliance with all applicable laws regulating c• ti n and zoning. Furthermore, I
a h•rize the above -named contractor to do the work stated.
. >.::.dti %OFFICIAL SEAL
S gnature of owner aid v , • . . •.Uta Es
Date: t • S Commission Expires
& � ° • June 4, 1996
'•44. c F F at" Comm. No. CC 205953
Notary as to Owner and /or Condo President
My Commission Expires:
* * * *
RADON C.C.F.
Fire Other
Zoning Building i
Mechanical Plumbing
Address
Tax Folio
DADE COUNTY
i/ 3�d• 6 /T' 6 r
Master Permit # / / -
Phone
ING MECHANICAL ROOFING PAVING FENCE SIGN
Signatu
Date:
Notary as to Contractor or Owner - Builder
My Commission Expires:
Electrical
Engineering
or �; •grQ; •er
My Commission Expires
June 4, 1996
• Comm. No. CC 205953
!? NOTARY TOTAL DUE