PW-11-19-2635 CanceledCANCELLED FPL VIIR # 6353810
I�ikawrid" Shores Village M]
tPlubVac Works Departmen,�i aji 04
10050 N.W. 2"d Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 766.8972 T --
Public Works PermItNo..TW-1 F-1 1 --26
Permit Application
FBC 2004
UTILITY
-PermtETyim Public Works WATER
Owner's Name (Fee Simple Titleholder) Florida Power & Light Phone#: 305-529-6120
Owner's Address 4200 West Flagler St
City Miami State Florida Zip 33134
Tenant/LesseeName N/A Phone# N/A
555 NE B7 ST
Job Address (where the work Is being done)
City Miami Shores Village County Miami -Dade
Is Building Historically Designated: Yes N/A No N/A
Zip
Utility's
Gentrat;lo s Company Name FLORIDA POWER AND LIGHT COMPANY Phone #: (3051442-5150
Utility's
Genlw"F!s Address 4200 W. FLAGLER ST. — EPM / LFO
City: MIAMI State: FLORIDA Zip: 33134
Architect/Engineees Name (if applicable) Miguel Piacquadio
$ Value of Work For this Permit: $ -'0, 137
Type of Work: M Addition ❑ Alteration
Describe Work: REPLACE 1 POLE
Submittal Fee $
Notary $ _
Scanning S
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Phone ik 305-626-2764
Lineal Footage Of Work:
❑ New ❑ Repalr/Replace ❑ Demolition
.................... Fees ............. I......
Permit Fee S CCF S
Training/Education Fee $
RadonS Zoning
Structural Plan Review S
Technology Fee S
CO/CC
Bond S
6A
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lenders Name (it applicable)
Mortgage Lenders Address
City
State Zip
Slate
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 this issuance of a Public Works pemrif will) 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 fire person whose
property is subject to elfachmenf. Also, a 'Sad copy
of the recorded notice of commencement must be posted at the job silo for the first
Inspection whic urs seven (7) days after t buildi pemrif is Issued. In the absence ofsuch posted notice, the Inspection will not be
approved and reinsseclion fee will be c arge .
GL-
Signature Signature
Owner or Agent Utility Representative /-Gealraster
The Io going in meat was acknowledged before me this 04 day of October 20 19 by
VV iViam 1'tnCa , who is personally known to me or -who -has late used N/A as
idenlificalion, and whodid/did nol lake an oath.
NOTARY PUBLIC: *MC
OTTApp }I�1 C:
Sign: Sign:GLG /"Print: Print: Toro
My Commission Expires: My Commission km
--�. MARCIA�DEL TOROotary Public -Slate Of FloridaCommission # FF 913576y Comm. Expires Dec 1, 2019onded through National Notary Assn.
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APPLICATION APPROVED BY:
11/17/2005
Public Works Director or
his designee.