RF-07-1242Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APP ICATION
FBC 2004
AUG 0 6 2007
Y :aGe
Master Permit No. Q 7 /242
Permit Type: Elect ; ical
Owner's Name (Fee Simple itleholder) i Q £-
Owner's Address 1-50S jA,) 113 O
Tenant/Lessee Name
City
E -MAIL:
State
Phone # j —77 Zs'\ -1
Phone #
Job Address (where the wor is being done) 2 75 "4.0 402. 5+
City Miami Shore 2 Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
•
Contractor's Company Nam, G P./
Contractor's Address /6700 A/141 a .
City in(s(, State
Qualifier Name. w
tto
Phone #
State Certificate or Registration No. tE n° !co 7o
E -MAIL:
Zip ) °j l..-
Phone #
Certificate of Competency No. CC. (° 7 a 33
Architect/Engineer's Name ( f applicable) Phone #
Value of Work For this Permit $ ® 0 C a Square / Linear Footage Of Work:
Type of Work: ❑Addition ['Alteration
Describe Work: 11 t * , k (NIA e_
❑ Repair /Replace
❑ Demolition
*** *. *** ** ** *x* * * ** * * * ** ** * * ***
Submittal Fee $
Notary $
Scanning $ �=
Bond $
Structural Review. $
Permit Fee $
eesx, xlYx+c4caY*****]txxxx**xxx xxx**%******** *** * ***
CCF
Training /Education Fee $
2,110
Technology Fee $
Radon $ DPBR
Code Enforcement $
Double Fee $
CO /CC
GI .DC)
Zoning $
Total Fee Now Due ?be) I .00
See Reverse side -+
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. 1 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. l 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and ', reinspection fee will be charged.
Signature
Owner or Agen
The foregoing instrument was ackno dged before me this
day of ,20_,by
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Signature
7
/ontractor
The foregoing instrument was acknowledged before me this26
day of 476 , 200% , by4,0 G. A (:;49e'Re
who is personally known to me or who has produced k
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Sig
Print:
My Com
*** 4eaY*u'k'+:tir *'k*a4** ******xxxxxxx x****sYdek4e** xxxxxrxxxx uxx xxx rx** xxxx***************** ****$to,Ydr *,'za;xxxxrxx***w***
APPLICATION APPROVED BY:
(Revised 02/08/06)
Plans Examiner
Engineer
Zoning
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 3318
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION D cT777
FBC 2004 SEP 0 6 aul
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder) Phone # ?� Seic,1
tSoSi,i
ft
BY:
Permit No. 101 — (8
aster Permit No. PC °6 -0-12-WZ
Owner's Address
City h
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done) /4-'24 /C7
City Miami Shores Village County Miami -Dade Z p
FOLIO / PARCEL #'.
State
Zip
Phone #
is Building Historically Designated YES NO X
Contractor's Company Name cPE
Contractor's Address (zoo it3 ' -8 1\10. 0
City
Qualifier Name
Phone # '3 0 5 - 968 -9442-
t1iA-w
State Zip
Phone #
iY ?ci) Pa t t
State Certificate or Registration No. Certificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if applicable) Phone
Value of Work For this Permit $
Square / Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration ew
�( ❑ RePair /Replace El Demolition
Describe Work: ° ov,_ 1 O* (L c®L
*** *** ..XXXXXX XY. *% #GCB: Y.XX XlCXX XXY.$C*'*w***w* Feesw**** XXXd: xXXXXXxwwwwwxr .XX*X*XXXXXXXXXXXXXk*w
Submittal Fee $
Permit Fee $
Notary $ Training /Education Fee $
Scanning $•w Radon $
DPBR $
CCF $ CO /CC
Technology Fee $ Z -5(J
Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ '.
Total Fee Now I ue $ (tJ(O °
See Reverse side -+
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 .' reinspection fee will be charged. /
Signature
Owner or : a t Contractor
The foregoing instrument was ac owledged before me this The foregoing instrument was acknowledged before
day of , 20 __, by day
who is personally 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: NOTARY PUBLIC:
Sign: Si
Print: Print; "` Q MY COMMISSION # DD 271987
My Commission Expires: M C
"ter 0o. EXPIRES: December 3, 2007
Y 1+pFANxp l ivotary Discount Assoc. Co.
***************************************************************************** * * * * * * * * * * * ** * * * * * * * * * * * * * * * * **
(Certificate of Competency Holder)
State Certificate or Registration No. Certificate of Competency No.
**************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *; * * *,, * * * * **** *************** * * * ** * * ** * * * * * * * * * * * * * * * ***** **
APPLICATION APPROVED BY:
Chc 10/14/03
.15—Z9,1'e')'''Plans Examiner
Engineer
Zoning