EL-11-4203/1/1/- Atgr--
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Eldctrical
Owner's Name (Fee SinSple Titleholder) L SCO L . Coansphone
q .
City
Owner's Address
E -MAIL:
E -MAIL:
Type of Work:
Describe Wo k:
Submittal Fee $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
State PI
Tenant/Lessee Name Phone #
Job Address (where the work is being done)
City Miami Shores Vile ` � Co' a Dacig
i /Vl Zip
FOLIO / PARCEL # f ""
Is Building Historically. Designated YES
Contractor's Company Name
Contractor's Address
City m Wan r
Qualifier Nam
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
Value of Work For thi; Permit $
Structural Review. $
Addition
NO
6 I►T r� _
t W
Zip
❑ Iteration ['New
Permit Fee $ /ere"' r ®e)
Master Permit No.
brvo.<a 21 C10 - '
State
Zip
Phone # 1 i = 5
Certificate of Competency No.
Square / Linear Footage Of Work:
❑ Repair/Replace ❑ Demolition
CCF
Permit No.
920
CO /CC
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Total Fee Now Due $ sr, (4 0
See Reverse side ->
KO 0 d��a
C..
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name applicable)
Mortgage Lender's Address
City
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installaion 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 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 a�.rov= and a reinspection fee will be charged.
L342.-5-31-1&- 5
Signature .1 "
Signature
L-e=sz Ly
The fore 'oing instrument was a
day of
who is personally known to me or who has produced
NOTAR
(Revised 02108/06)
,. g e
, by
owledged
ore me this I
A . i . - ntification and who did take an oath.
NOTARY PUBLIC-STATE OF FLORIDA
e*""" Monica rb 3e? , 'iorez
Com_ nis. o!: #D1)967856
I I _ .. ?v1AY 03, 2014
A �II�I . /• i��'e t D C BONDING CO
it& 11 �
Sign:
Print:
My Com ission Expires:
APPLICATION APPROVED BY:
State r� Zip
State Zi
Contractor
The foregoin instrument was acknowledged before me this 3
day of 20 4 / , by
who is peronally known to me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
444_
Sign: IFIOTAPY: t 7 7 . C.'-r 1 .7,17 77 r''tDA
7
Print: J-Yb' �f psi LiI,I b , t � L I lid
My Commission Expires: ena (1
saitll ?U Phi li3uV�eire:0.�I1QC.
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Plans Examiner
Engineer
Zoning
Miami, March 10th, 2011
Attn: Miami Shores Village Building Department
RE: EL -3 -11 -420 Address: 286 NE 99 St
To whom this may concern,
We respectfully request to cancel the current permit pulled by ADT at the above residence at Miami
Shores. The order was cancelled by my husband and I prior to the permit being applied for.
If there is any additional information needed, please don't hesitate in contacting me at 305 - 450 -7762.
asp ---- --
Jacqueline P. James-. yttle, Ph.D., P.E.,
CEO
JAYLYTE Real Estate Investing