11-1243-005CITY OF SOUTH IYIIATNII BUILDING cox ROOFING PERMT ATTLICATION
6130 SUNSET DRIVE, SOUTH N IAitiil, FLORIDA 33143 205) 60 -6355
PROTECT ADDRESS: I 7�
PROPERTY OWNER: % I A) PHONE
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WORK TO BE PERFORM lED BY: CONTRACTOR 1,/ OWNER/BUILDER
CONTRACTOR ,�
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ADDRESS: %.'� z i , ay�3a
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TIlMS APPLICATION IS FOR THE CONSTRUC'T'ION OR INSTALLA'T'ION OF: (PLEASE BE SPECrLFIC)
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USE: RESIDEN'T'IAL COMMERCIAL �7
SQUARE FOOTAGE_ ESTIMATED VALUE
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I UNDERSTAi" THAT SEPARA'T'E PERMITS MUST BE 013TAINED FOR ELECTRICAL, MECHANICAL,' PLUMBING, ROOFING,
SHUTTERS, WINDOWS, EXTERIOR DOORS, PAVING & DRAINAGE AND SIGNAGE. BY SIGNING THIS APPLICATION I ASSUME
RESPONSIBILITY FOR THE COMPLETION OF THIS PROJECT IN ACCORDANCE WITH APPROVED CONSTRJ, ION DOCUMENTS
AND COMPLIANCE WYrH ALL APPLICABLE REGULATIONS.
SIGNATURE SIGNATURE OF PROPERTY OWNER
VICTORIA MARIA FAGUNDO °- r --- - -�
NOTARY: =�'_ NOTARY o1�?Y %'�:. VIC T(�RIA nres�ie FnI`la any
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�a EXPIRES May 13, 2014
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ZONING DISTRICT
ZONING
CODE ENF
STRUCT.
k
ROOFING
BLDG.
PLUMB.
I:
ELECT.
MECH.
CONDITIONS:
MMISSION A, DD991538
EXPIRES May 13, 2014
FLOOD ZONE MASTER PERTNUT NO.
TE 7—;ATE COMMENTS F FEES _-
CITY
COUNTY
l RADON
APPLICATION RECEIVED BY: PFRINHT NO.
FINE
REVIEW f:
TOTAL