1992 GASPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
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Date �d /Job Address o �aLae Folio
Legal Description ‘Vine / talky i �L/ Master Permit # 976
Tenant
Owne
Owner's Address
Contractin
Qualifie
State #
Architect /Engineer
Bonding Company
Mortgagor
?/
e Day -Time Phone
�Q �c Address ..
Competency#
Permit Type: ROOFING BUILDING ELECTRICAL PLUMB %NG MECHANICAL
WORK DESCRIPTION" ✓ " 7o ��" /A 1r / "fr*
Square Ft. Estimated Cost //,W. ® 6)
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 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.
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Signature of Property Owner or Condo Pres.
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NOTARY PUBLIC STATE OP F s 1
COMMISSION NO. CC]"
A
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Sworn to & subscribed before
of
Signature of Notary to Owner/
(Print, Type, or Stamp Commissioned Name)
Personally Known OR Produced I.D. E1
TYPE OF I.D. PRODUCED
Zoning
Mechanical
Building
f
Address
Address
Address
Signature of Contractor
P
(Print, Type, or Stamp C . issioned Name)
Personally Known OR OR Produced I.D. 71
TYPE OF I.D. PRODUCED
to & sub
Phone
Ins. Co.
ture of Notary to Contractor
PAW
Electrical
Engineering
PAVING FENCE SIGN
befar io lx s day
April 7, 1995
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IMP
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1
SINCE SE9s
OIvai1Ou O//ICLS
2300 BISCAYK: BOut tvAAO • Y.O. BOX 4431
• MIAMI. /tOR10A 33S01_
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- i :ter S'i' MM
SINCE 1895
DiVIsioM OFF.CES
• 2300 BISCAYNE BOULEVARO • C.O. BOX 4421
MIAMI. FLORIDA 33101
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