EL-13-276Miami Shores Village
Building Department MAR 1 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138BY:
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.494
BUILDING
PERMIT APPLICATION
Permit Type: Electrical - r
JOB ADDRESS: 133 IJ Uri q 104
FBC 20 � -D
Permit No. �_L 13— 2--7
Master Permit No.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): IS�t qnd LN, Phone#: 49---62391
Address: 110 uV 9Z 4.
City: 9 iati; b�('t" State: ft Zip: 35156
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name:
Address: `5,7MM
City: !t,/ / / V iq / , State:
I
Qualifier Name: I d� At Phone#:
State Certification or Registration #:l Certificate of Competency #:
Contact Phone#:�t«���� % Email Address:
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $ G "A /
�{�.y • Square/I.inear Footage of Work:
Type of Work: ❑Address f
Description of Work: "
❑New ❑Repair/Replace ❑Demolition
f-- (_ 1 `3 - '2,7-7 <o
�J
Submittal Fee $ Permit Fee $ ' CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ 1 S9 - C7�
Bonding Company's Dame (if applicable) _
Bonding Company's Addresst'
City ' State
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 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 commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. he absence of such posted notice, the
inspection will not be approved and a reinspection fee will be /charged.
Signature L Signature -
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this L The foregoing i strument was acknowledged before a this
day of Fibruary_, 20 Jam, by PS r4rand V r I ler =U;� by
who is personally known to me or who has produced o me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
NOTR
PUBLIC:
Sign: aQ w,aCZ+.Q�
-.01MY11. ,i,., _a DiazSign:
`
Print: ZiQo 1 'fit clz.
COMMISSION # EE014022
Pri
My Commission Expires:
:,F , o;°=EXPIRES:AUG.02,2014
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mi si x fires: JOUeER? 'IERRE
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Notary PL:blic State of Florida
• ; ; • = Niv Oomni. Expires Apr 30, 2016
commission # EE 194096
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APPROVED BY ��
i�//s2%1Plans Examiner
Zoning
Structural Review I Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)