EL-07-2197Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
D Permit No. EL TZ'T7
PERMIT APPLICATIOEIVE
Master Permit No.
FBC 2004 OCT 2 9 2447
Permit Type: Electrical 0
Owner's Name (Fee Simple Titleholder) `vr`Q IC V=' ` Phone # 3 (D
Owner's Address 3 )• LJ --
City SV -O •C e,& State L Zip 3 11 D
Tenant/Lessee Name Phone #
E-MAIL:
Job Address (where the work is being done) S (--, ks AA,U q --
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO X
Contractor's Company Name
Contractor's Address
City Sta"
Qualifier Name V
State Certificate or Registration No.
E-MAIL:
Phone #
A:::—Z—ip—::
Phone #
Certificate of Competency No.
Architect/Engineer's Name (if applicable) C -e -k_ G f(,s,, LLC Phone # '[ " S (' %
Value of Work For this Permit U , 0 D
Type of Work: Addition Alteration
Describe Work:
Submittal Fee $ Permit Fee $
Notary $_
Scanning $
Bond $
Structural Review. $
Training/Education Fee $
Radon $
Square / Linear Footage Of Work:
New Repair/Replace " , Demolition
DPBR $
CCF $ CO/CC
Technology Fee $
Code Enforcement $ Double Fee $
Zoning $
Total Fee Now Due $
See Reverse side —>
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
r
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 commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature CDIa Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 0"-q The foregoing instrument was acknowledged before me this
day of Oe,'4yb a / 20 by ! li61ZO 'DIA YM 1, day of , 20 _, by
who is personally known to me or who has produced i
14C 643goo As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
P SS(NOO
3 70,s Sign:
M c1P P
SHpU
Print:
My ComnusstdTi'Expires: My Commission Expires:
xrx xxn x*,*x xxn*xx;xx*x:**Kx,x x,xxxx**+rrxxxrxxx*xxxrxxx xxr*Yxxxxxx,xxx Yxx*x,*,*x*x*x x
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
Revised 02/08/06)