EL2004-221BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle):
Owner's Name (Fee Simple Titleholder) . Phone #
Owner's Address
C ity
Tenant/Lessee Name
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 4
Tel: (305) 795.2204 Fax: (305) 756.8972
Building Electrical Plumbing Mechanical
State b c°- Zip
Job Address (where the work is being done) 7 �, c, , s \,;,, ti e
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name Phone #
Contractor's Address
Ci State - s _ Zip
Qualifier
State Certificate or Registration No. k
Architect/Engineer's Name (if applicable) >.
S Value of Work For this Permit-4--. ���� f C Square Footage Of Work:
Type of Work:
Describe Work:
'jA
Submittal Fee S
Notary S
Scanning S
Code Enforcement S
Total Fee Now Due S
(Continued on opposite side)
❑Addition ❑ Alteration New
$ tom 4.4.)./3-;y„,/ //11; ;7
i
* * **** *** **** * * * * ** * ** * * * *** Fees * *K***** ** *** * *** ** * ***** *****
Permit Fee S s' 7 e CCF $ . CO /CC
Technology Fee S
Zoning Bond S
Structural Plan Review. 5
Training/Education Fee $ 6 0
Radon S
Miami Shores Village
Master Permit No.
Phone #
Certificate of Competency No.
Phone #
El
Permit No. k. 4- l I
Rypair/Replace
7 1.<y/) 4
Roofing
❑ De„molition
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 In the absence of such posted notice, the
inspection will not be approved and a reiaspection fee will be charged.
My Commission E
Chc 05/13/03
Cowl°
NOTARY PUBLIC:
Sign: A.
Print:
* * * * * * * * * * * * * * **
C;F}Nt tia.:. NOV
:14 z!^0.41f
X733C;`2
Owner or Agent
The foregoing instrument was acknowledged before me this r 4 V The foregoing instrument was acknowledged before me this )'
day of � .,a: - , 20n , by
who is pe known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign: o.
Print:
0
My Commission Expir
* ** *1 415 #1"5' ?o* "; * **
day of
,20 by
e.
************* ********** ****** *********** **** *************** **** : s ********** k* ******:k ***** ***** **** ** ** *** * **
APPLICATION APPROVED al?' i � � �' £ - / tan
�.�- _ �/ s'(�� ,� C- � ��� Plans Examiner
Engineer
Zoning
MOODY n ELECTRIC, INC.
www.moodyelectric.com
669 N.W. 90 Street ^ Miami, FL 33150 -2166
Tel: (305) 758-2000 Fax (305) 754 -1333
3� 13 S.
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MOODY n ELECTRIC, INC.
www.moodyelectric.com
669 N.W. 90 Street ^ Miami, FL 33150 -2166
Tel: (305) 758-2000 Fax (305) 754 -1333
3� 13 S.
•.s.) 3( 0 T Arw\
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Applicant:
Owner: RODRIGUEZ ISABEL
JOB ADDRESS: 736 NE 92 ST 1K
Contractor MOODY ELECTRIC INC
Local Phone: (305)758 -2000
Parcel # 1132060440290
Electrical Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204 Permit Number: EL2004 -221
Printed: 8/6/2004
Contractor's Address: 669 NW 90 ST
Legal Description: SHORES PLAZA EAST CONDO UNIT 1K - 1ST FLOOR UNDIV .01907% INT IN
Fees: Description Amount
FEE2004 -7994 Building Fee $175.00
FEE2004 -7995 CCF $1.80
FEE2004 -7996 Training and Education Fee $0.60
FEE2004 -7997 Technology Fee $4.37
Total Fees: $181.77
Total Fees: $181.7
Total Receipts- 0.00
1
Permit Status: APPROVED Permit Expiration: 1/31/2005 Construction Value: $2,400.00
Work: NEW METER ROOM CHANGE OUT NEW GROUNDING 5 GANG METER
Signed: (INSPECTOR)
Page 1 of 1
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict
conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
•