PAINTPermit Type (circRe one):
WORK DESCRIPTION(
ML�ii9L �2-t p .
Signature of owner and/or Condo President
FEES: PERMIT
PERMIT APPLICATION FO
Address
Date Signa e of Co
0
Date Job Address /e33 A/ �
Legal Description 1
Owner/Lessee / Tenant ( /5 /'f 4 ) ►� o R . ( ,4 L
e iery o
Owners Address j616
Contracting Co. X h Mt' hvTiN 4 /1/ /g am
rPOIVD
Qualifier SS# Phone
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
76-te 0 P Ov6 14r9 lu b .
Square Ft. Estimated Cost (value) ,/ 42_, fr
WARNING TOO R: 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.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
RADON C.C.F. �' . 11.° NOTARY S BOND
• v
4.
I, ��2L��
1
ctor or Owner -Bui der a N 0�
U�f �/ 5�/ 2 `f
Notary as to Owner and/or Condo President Date otary as to Con
My Commission Expires: My Commission E Cpirees: i 1 Date
CSG� 2.O I S,
Ill ?psi 1 °' NG. c! e ���3 ∎�
CO. 2StON EX Y' `3. li sx :
APPROVED: TOTAL DUE
Zoning Building 1 11 14 1 Electrical
Mechanical Plumbing Structural Engineer