EL-09-1341Miami Shores Village
Building Department
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 APPLICATION
FBC 20
iii:VMZUMN
�! AUti 12 2009 IP
BY:_m_ m_.s......
Permit No. ti 0 Fi — 1 31-1
Master Permit No.
Permit Type; ELECTRICAL
Owner's Name (Fee Simple Titleholder) / 4 %'/q / c_c et9 106-7-Phone #
Owner's Address /D 6-6-" 4% 94.
City 9-c �� State Zip
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done) /12 56.11J6
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historical ly Designated YES NO
Contractor's Company Name Lf% Tip s„) c- Phone #
Contrac is Address 41 7D Iv 3 8 P..
City //� State —�� Zip 33 d /3-..
Qualifier Name v, -nJ 4)4) Phone # 786/9 9:5-"" 9/ 6 g
State Certificate or Registration No..--re ®a /® 9./g. Certificate of Competency No. 1pPJ ' 464 en
Contact Phone E -mail
Flood Zone
.3o�/8�y1 a 7 as 9,
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ -5' 0D O , ® 0
Type of Work: ['Addition ['Alteration ['New
Describe Work: t E P ,1I
5 "2-4 -5 F o ATE e_729 fe 5
Square / Linear Footage Of Work:
6
/Replace
❑ Demolition
/ �-
iI
G 12 PAlt, **
********** *: x*:*********,x**** * ** *F *********i* * ** * * * ** ****** *** * * * * * *s * ** * ****
Submittal Fee $... a
Permit Fee $ 07 Pt&®
CCF $ 3' 00 CO /CC $
Notary $ 5.00 Training/Education Fee $ 6.00 Technology Fee $lU
Scanning $ 3'b0 Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $
See Reverse side -4
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 FI.F,CTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AMR CONDTTIONERS, 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 i sued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. q
Signature
The fo _; going
day of
who is
NOT 1 Y UBLIC:
Owner or Agent
Sign
Contractor , L
strumenntt0was a s wledged before me is �� The forego' instrument was acknowl ed before me this �! "I•
,2003by • Y Y -
e • wic day f , 200 , b A d.lJ,tJ ikez ,
nally known to me or who has produced is personally known to me or who has produced
SSlentification and who did take an oath. as identification and who did take an oath.
Sign:
Print:
My Commission Expires:
• .6 Or
'1 ( . " *
1�av CPB`�A�1
My Co ission OT es. . • Eddie xsidrmn
•. e 0ommissio 19, NOV. 2012
a? Expires:
BOND°ID1URII ATLANTIC BONDING CO., INC.
* R,k********** *********** * k**** *** *****+k** **** ****#+ k**+ k***** ***********# ak: k**** *********** * *******+k *****
APPROVED BY
l211ms Examiner Zoning
Engineer Clerk checked
(Revised 07 /10 /07XRevised 06/10/2009)