31162PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
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Date /Job Address
Legal Description /41
Master Permit #
Owner / Lessee /Tenant
Owner's Address
Contracting Co.
Qualifier
,0k.5%^ /ate Address
t ''
Phone
90 -</-", y<e �T
SS# /: Phone
State# Competency# GZ 4 t' hie Ins.Co.
Architect /Engineer
Bonding Company
Mortgagor
Address
Address
Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION
,7�Tf /5177,eij'
Square Ft. Xis �,r/�. Estimated Cost _&l®,t'e
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO MAX RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
ZECORDING YOUR NOTICE OF COMMENCEMENT).
1pplication is hereby made to obtain a permit to do work and installation as indicated above, and
In 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
)ermits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work.
WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
ill be done in compliance with all applicable laws regulating construction and zoning.
'urth:ezmore, I authorize the above -named contractor to Bo the work stated.
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1 -6t,4) fru Cl1
_ignature of.Owner and /or Condo President
2tfe s.
to Owner and /or Co do President
y �:omission Expires: pires: V/// *
* *
=KNIT FEE: APPROVED: Fire
Signature of Contractor or Owner - Builder ° -
Date:
tar ` as to ontractor wi
Oer-Buildez
Commission Expires: /0X
* * * *
*
Other
Zoning Building q* 5Y, ) Electrical
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hanical Plumbing Engineering
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7-74,(10
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