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EL-07-200Building Department 10050 N.E.2nd Avenue, Mani Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING b � PERMIT APPLICATION FBC 2001 EIectrical Permit Type (circle): Building Owner's Name (Fee Simple Titleholde Owner's Address City Tenant/Lessee Name Phone # s Job Address (where the work is being done) z. v yer p , City Miiand Shores Village County ;Dade Zip ∎' 3/ Is Building Historically Designate YES NO Contractor's Company Con ctor's Address City Qualifier t Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit / 7)0 ' Square Footage Of Work: Type of Work: ['Addition ■Alteration ENew ❑ Repair/Replace ❑ Demolition / Describe Work: i / AP 1 ■wmirAtmierzw _, * * * * * * * * * * * * * *** ** * * * * * * * ** F ees * * * * * * * * * * *** * * * * * * *** * * * * * * ** Submittal Fee $ Permit Fee $ f ©e, r Notary $ Training/Education Fee $ Q L2L7 Miami Shores Village Scanning $ 3•(r)(3 Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ fpm 'TO) (Continued on opposite side) 0 7PA r IMOMRWEIN ta FM �� 2 2007 Permit NO. 1 Cr Master Permit No. Plumbing Mechanical Roofing Phone 4 ,..5/ d? / CCF $ O'er.../ CO /CC Technology Fee $ 2• 9Worgr-d--- 7?1 Company's Name (if applicable) B�;r ding Company's Address City State Zip ge Lender's Name (ir ^.pplicablel 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 O'77TER'S ' AVIT: 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 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 wilco ap•roved and a reinspection fee will be charged Chc 12/15/03 i e • 1/ soe 0 44 (6 O S i �S gnahu' � � S c t o2 gnatine � S Aled Owner or Agent who is pers known to me or W As identificati LAW on and who NOTARY PiJJ3LIC: Sign: �i� v` P My Commission Expires: APPLICATION APPROVED BY V ede- ******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Certificate of _Competency Holder)_ Print My Commission Expires: State Certificate or Registration No. Certificate of Competency No. this - - -- The foregoing- instrument was - acknowl ged b , day of Z 7 , 20�by� who personally kno to me or who has produced @ , as identification and who did take an oath. OTARY PUBLIC: Sign: P , Notary Public State of Florida Kevin Hicks My Commission DD613641 **************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Inns Examiner Engineer Zoning