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EL-16-2967 (2) Miami Shores Village Building Department OCT 3 � X016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 LBYY: Tel:(305)795-2204 Fax:(305)756-8972 ®o�►A INSPECTION LINE PHONE NUMBER:(305)762-4949 (FBC 20 ILA n BUILDING Master Permit No. C [(o_ 2 ct PERMIT APPLICATION Sub Permit No.E ( l(o - 2.9(�- ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP j CONTRACTOR DRAWINGS JOB ADDRESS: :! ` Ze X-)I!'=— City: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE:_LjQ FFE: OWNER:Name(Fee Simple Titleholder): VO4VA�70101114MI& l ,rte ' Phone#:�a i- -1 �1 ®U,YJ t Address: --71. (D to I NE q)-" SIT City: v r� ��s� Stater. zip: ?3 i 3 r Tenant/Lessee Name: Phone#: Email: yy�� / _ / CONTRACTOR:Company Name: - I�2/� one#: tom/ Sa l� Address• p�' �--f S4/ti 7Z -� City: if u State: _ zip. 0/si Qualifier Name:_ 14-1 kf l i f Phone#: State Certification or Registration#: Certificate of Competency#: ©� dr7252- DESIGNER:Architect/Engineer: Ile Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 150z:> Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: eo tic- ();o 1-A"4 N ,a/i•t� L9 J► t y( Specify color of color thru tile: rrr�� Submittal Fee$ �d PAI Permit Fee$ `✓��j°° CCF$ ° V CO/CC$ Scanning Fee$ Radon Fee$ Z S DBPR$ 2� Notary$ Technology Fee$ Training/Education Fee$ ° �® Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 109 • "D (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs a (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved anidtf reiml pection fee will be charged Signature s Signature O�NER or AGENT / CONTRACTOR The foregoiinstrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 4�� 20 1, by day of Att-OwV 20 l� •by who is personally known to � �,t ----,who is personally known to me or who has produced l 6 Z-- as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign. /vv Sign. Print: ' Prin State of Florida Seal: ;,NtkyP`4 JIM!D.PAMPLIN Seal• •%f � Commission# FF 116240.,of F._: ° Notary Pubtate of Florida �� ",My Comm. s Jan 13,2017CommissEE 864892 �h4n UP #�k#ek�It�]c ek yt ek4yt �It APPROVED BY �1,�%Z l ✓i9"Jr/i y Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) I ELFC71Rlca L cowrRmcroRs, INC. E 19150 S. St And-'ewk2)i M FL. 33015 I Phone:786-621-5215 Fax: 786-621-5216 Invoice #2016023 _ 01/18/2017 Ray Carabotta 428 NE 91 St Miami Shores, FL. Invoicing for the necessary labor at the address referenced above: • Fumish and install 5 new GFI's outlets throughout kitchen area. • Fumish and install 3 new GFI's outlets in bathrooms. Total amount to complete $5 O • . .... ...... ...... . ...... :fee*: f • I E I 'cal Contra , Inc. •..• ; Gee ]esus Villegas Sales Person.