EL13-2734Miami Shores Village )
Building Department
J 2ui3
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: -__
(2_2� --------------
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20
BUILDING Permit No. 3 `i
PERMIT APPLICATION Master Permit No. 1 `332
Permit Type: Electrical
JOB ADDRESS: 515 N E 102 SiTee t
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 - 320ty + 0 (1 O X
Is the Building Historically Designated: Yes NO X Flood Zone:
OWNER: Name (Fee Simple Titleholder): U UD tan Phone#: (404) 4 02 - (p812
Address: 1513 06 10 Z styee t
City: M lami sha'( eh State: F L. zip: 33 Qi5
Tenant/Lessee Name: NIA ^ Phone#: (40q) 1402 - (05-1 z-
Email: (100tO� Y 1 r V-0 65 Q r 16t I L OCA d
CONTRACTOR: Company Name: E'AI171 eP.i»n�q. S Y CIS' Phone#: C� 8 (P) 2.39 —1 S O 5
Address: 1355 SVq E>,Q St -# Lill
City: M fol ml State: F L zip: 3 31
Qualifier Name: W U Oordo b a r refio Phone#:
State Certification or Registration #: E "3005I ( 13 Certificate of Competency #:
Contact Phone#: (Z>OS u?O"ass5 Email Address: eQ-i7 S�t"V 1 CV) (0)QmOLA LO.WI
DESIGNER: Architect/Engineer: W u a-r(W 'ROL(rv" Phone#: (yacg) 7zcl "!zoid,
Value of Work for this Permit: $ 1 r 2-CO Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration >4New ❑Repair/Replace ❑Demolition
Description of Work:
Submittal Fee $
Scanning Fee $
Notary $
Permit Fee $ 4' 0 CCF
Radon Fee $
Training/Education Fee $
Double Fee $ Structural Review $
CO/CC $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 commenceront must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the ence of such posted notice, the
inspection will not be approved and a reinspX-rtion fee will be charged. /t
Signature ,L/ , �-// / / ,/ Signature
v Owner or Agent v I " Contractor
The foregoing instrument was acknowledged before me t is _J The foregoing instrument was acknowledged before me this 3
day of ( by V day of ___ 0 1, by E t✓ar
who is ersonally kno to me or who has produc who's personally kno o me or who has produced
As identification and whd�Id take an oath. as identific�lion and who did ak an oa
NOTARY PU IC NOTARY P I
Sign: ` Sign:
Print: a 1' N E. GUARDIA Print: SON k
;•, ��1` �- EXPIRES: July 4, 2017 F; d onded Tim' Not Pubii
My Commission Expires: J ri g �IdedTh.NOWPOWUndeiw hers My Commission
�a 47
APPROVED BY ���� Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)