74 NE 111 StPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
Job Address
Legal Description / (gar
Owner / Lessee / Tenant �/
Owner's
Contracting Co.
Qualifier
State #
Address 7)/ ; v), /
Architect /Engineer
Bonding Company
Mortgagor
Of-awl/I
Permit Type (circle one): BUILDING ELECTRICAL CP- LUMBING IhrHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
Square Ft.
, B0
5 :0 7 ) 1 1 1-
35 5 .5" 0
Zoning
Mechanical
Signet re f Oiiner and /or Con or-esident
Date:
PERMIT FEE: APPROVED: Fire
(OWNER TO RETAIN COPY)
SS#
Address
Competency# Ins. Co.
Address
Address
Address
- - phone
Estimated Cost
Tax Folio/ .Z/,./(p tY 070' f
Master Permit # fa e
phone
/to Oh pe
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: certify that all the foregoing information is accurate and that all work
will be done • with all applicable laws regulating construction and zoning.
Furthermore, •riz= t} 7abo -names contractor to do the work stated.
Signature of Contractor or Owner - Builder
Date:
Not y a$/ to Owner and fjegric9 MWC.trIg$OleEip10A' Notary as to Contractor or Owner - Builder
My mmission ExpireMT COMMISSION EXPIRES APRIL 16. 1992 : 'My Commission Expires:
* * *BONDED TA STEMBLERAMS & SWEE* • *
Other
Building Electrical
Plumbing )ZEngineering