RC-18-247, 1284 NE 94th St (3)Miami Shores Village
Building Department„N �� �o1s
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Z
Tel: (305) 795 2204 Fax: (305) 756-8972 \\\-1'
INSPECTION LINE PHONE NUMBER: (305) 762-4949 (-O -h
BUILDING
PERMIT APPLICATION
❑BUILDING ❑E ELECTRIC F-] ROOFING
FBC 201--:1
Master Permit NO.RC 18-247� I'3'y
Sub Permit No. RE -4-& 4 ��y_ ��— loci
F-] REVISION ❑ EXTENSION []RENEWAL
[]PLUMBING F-] MECHANICAL F]PUBLIC WORKS F] CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1284 NE. 94th St.
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3205-010-0140 Is the Building Historically Designated: Yes NO
Occupancy Type: SFR Load: Construction Type: CBS Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Suzanne J. Glller f/k/a Suzanne Jacobs
Address: 1284 NE. 94th St.
City: Miami Shores State: FL
Tenant/Lessee Name:
Email
N/A
CONTRACTOR: Company Name: AJL Electric, Inc.
Address: 14-'156 AI LIJAe.2 iJl
City:
Qualifier Name:
Phone#:305-754-4482
Zip: 33138
Phone#:
Phone#:
Zip: Phone#:.30 `Fy 5 (� �/
7'
{= 0zoo
State Certification or Registration #: oi-SnzivzR- t Certificate of Competency #:
Architect/Engineer: Address:
Phone#:
Value of City: State: Zip:
W.Addition 00 Square/Linear Footage of Work: Approx 85 sq ft
❑ A Alteration ❑ New 0 Repair/Replace ❑ Demolition
Description of work: Electrical work associated with updating 2 existing bathrooms, including change out switches
and install new GFCI outlets as needed.
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
CO/CC $
Notary $
Double Fee $ _
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ 40
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address
City State
WE
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
i
Signature
OWNER dVAGENT
The foregoing instrument was acknowledg d before me this
day of i car U a� 20 ' , by
Suzanne J. Giller , who is personally known to
me or who has produced FL Driver's License as
identification and who did take an oath.
NOTARY PUBLIC:
MAFiARAI K. GONZALEZ
�SP;::�9 c• i S
Sig ?a°' MY COMMISSION # GG 044602
EXPIRES: NoVeMDVI
Print:
%�•••�ro'� BondedThruNotalyPublic Underwriters
Seal:
APPROVED BY
Signature ii
CO A OR
The foregoing instrument was acknowledged before me this
day of 1-4- c C--b J 20 j by
nf�Lti� Y. L w,) a -�$vho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
r
r
Sign:
Print: KIM ECKHARDT
�+���° EXPIRES' February 12, 20I9
Seal:
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk