ELC-11-94Miami Shores Villag
Building Department ' \\ JAN 1 9 2011
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972. •°°°'° --"°°°°°-
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING Permit No.E 11 ` f
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: ELECTRICAk
Owner's Name (Fee Simple Titleholder) 0 - 1..--0...., Phone # 7a0 42-3 - 5 i Or
Owner's Address 9 -Iy k..1 a.,. cg c( c/ ... 11'
City m P---r-C-1.' U /a'.04 State Zip 3 51 38,
Tenant/Lessee Nan ? 1-4 a> 1 E+ o `I( �r -,1
Phone #
Email
Job Address (where the work is being done) 953 d 7 A.L R' -
City Miami Shores Village County Miami -Dade Zip 33/ 3 i .
FOLIO / PARCEL # #` 302.6 4-- b /3 - 37/0
Is Building Historically Designated YES NO Flood Zone
C ontractor's Company Name A `v " . See z e ` one # (qir) 3 4
51 3
Contractor's Address f o'2 f S 46%
City State .. Zip
Qualifier Name /. i/d ' Phone #
47:! 47/
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
Type of Work: ['Addition/%
Describe Work:
VW. g
teration
Square / Linear Footage Of Work:
QNew 0 Repair/Replace
0 Demolition
*'//'CGS'" /O
********, * * * * * * * * * * * * * * * * * ** * * * * * ** ** * ** Fees************** * * * * * * * * * * * * * * * *,* ** ** * * * * *****
Submittal Fee $ Permit Fee $ lat3, 4T9e" CCF $ CO /CC $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $
Bond $
See Reverse side
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
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: 1 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 O WNER YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT 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 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 beeaar' da re- inspection fee will be charged.
Si
Agent Jl
The foregoing instrument was acknowledged before me this (1_The fore
day of j'tlwc. , 20 l l , by-A edeS * eetwo hese , day of
who i s personally known to me r who has produced who is
Signature
CAJO
As identification and who did take an oath.
NOTARY PUJBLIC: N �fy1TATE or =numm
Commission SDD795680
", Yaniv Offir
• ;n01 Expires: AUG. 22, 2012
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My Commission Expires:
* * **
Contractor
g instrument was acknowledged before me thi/ /PI
20 % /,by
sonally known to me or who has produced
as identification and who did take an oath.
Y PUBLIC:
/97.02i€1/ Plans Examiner
Engineer
(Revised 07 /I0 /07XRevised 06/10/2009)
NOT
Sign: 4:04'1*—‘°'
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Print:
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JULY 26, 2011
Zoning
Clerk checked