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EL-08-1454BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) /7 City Miami Shores Village FOLIO / PARCEL # /'fsia -3o v • C77 6 ;L.47 City Qualifier Name State Certifite or E-MAIL: E • Architect/Engineer s Name (if applicable) Radon $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Owner's Name (Fee Simple Titleholder) 1 '(J , R 4 "Ar' ST k ? Phone # 3 11 1 d °� a Owner's Address l7 O 6 Al ' l o f t r. moo/ Ci / 1tm /- sP lfrn/.` P State Zip 33 I iv y Dade Zip 973/ ? wit 10 2 C n 44 ,44 , Building Historically Designated YES NO Contractor's Company Name \ 'A{ t lC,4k. Ci fim-Vtg.a Phone # Contractor's Address ` • //�� State .._ Zip ZIOt 'C�. AWL Phone # 2, u Qtsb- Sua 4. n No. '7 ©t 00 0ieolle rfc®e g V'al ' fl nt this Permit $ 2 6 ' Square / Linear Footage Of Work: e e 1. hype of 3❑/ ddition ['Alteration ❑New Repair/Replace [I Demolition r , • r f i ❑ Re air /Re lace °" bescrill� VYi3 $c: t 0i2 /C - le ..X- l - ,- — , , . w�'Q -✓" rY�—® • ******** * * * * * * * * * * * * * * * ** * * * * * * * * * * * * ** Fees************* ** * * * * *xxxxxx * * * * * * * * * * * ** * * * ** Permit Fee$ /6 0 ®,e%' Submittal Fee $ Notary $ Training /Education Fee $ Scanning $ .1na Bond $ Code Enforcement $ Dou Fee $ Structural Review. $ tr1. Fee DPBR $ AM 7 2008 CO MIAMI SHORES VILLAGE Permit No. rat( ster Permit No. Phone # Phone # Certificate of Competency No. 'OZE tOZ .Q 1 CCF $ 1 CO /CC Technology Fee $ 4+ /2- Zoning $ 168.72 . ee Reverse side -4 ft- Bonding Company's Name (if. applicable) Bonding Company's Address City State Zip d�r's (if applicable) diOr 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 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 c niinenc` n'kent \a nsr rurrinn l►a l brochure w ill be delivered to for the first inspection which occurs seven (7) days after the uit in - i tc of Tun fat must be posted at the job site the person whose property is subject to attachment. Also, a cerk eg�co pv�¢j��i p - � .fence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. t -' ieOl,I.,- Signature i L . / 4ti Owner or Agent - C.- Contractor The foregoing instrument was acknowledged before me this L( The foregoing instrument was ackno !edged bef e me this day of f� , 20bY, by hT day o 20O/G by :0 ' -- ersonall known to me or who has produced FL is + y P � w i s personally known to r wh � has p oduced ► As id Y'PUBLIC: A ' LICATION APPROVED BY: (Revised 02 /08/06) tion a State Zip who ) id� did take an oath. ommission Expires: Aftiptik ( 12.-0 ** * *** * * * * * **** * * * * * * * * *' * * * * * * * * * *xxx 1A4 "Or as identification and who ��)�an oath. NOTARY PUBLIC: s •`�P $EOAN F� '•, • • r • • • • Sig Print: � � I• k-N01U5' *.e ►11111111` Ce Plans Examiner My Commission Expires: * x****x xx xxxx* * * * * * * * * * * * * * * * * * * * * * * * * *d1* Engineer Zoning •