EL-09-187111bmkoi - a{mor Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical
■Owner's Name (Fee Simple Titleholder) Z..5'516-- ,3
Owner's Address 2 30 IV 7 _vre9
City • / State L 4
Tenant /Lessee Name
E -MAIL:
..„,,Jeii Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Permit No. F-09
9
Master Permit No.
18 (0-23U -- 2111 Poty r or
Phone # ;Iff- 3i'
Zip
Phone #
pZ 3o
County Miami -Dade Zip
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address 20 3
City t9 P, 4 JiBC./
NO
Qualifier Name
State Certificate or Registration
E -MAIL:
lQ Le) c et f C U A
State
Phone # s6.AS' 7/ ;3
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ 7.90
Type of Work: ['Addition
Describe Work: 11
aeo
Zip 3,,,w
Phone # $ , ARF g 7L 3.3
Competency No. C
❑Alteration
Phone #
Square / Linear Footage Of Work:
EINew
[t-- lepair /Replace ❑ Demolition
* * * * * * * *i: **
Submittal Fee $
Notary $
Scanning$ (3•00
****xx xxxxx* x*** x******* Feesic> rr.* ***** *********** * ***** ********* **x9c *x *x
Permit Fee $ % ,0G °4:24' CCF $ • w b CO /CC
Training /Education Fee ' Z 0
Radon $ DPBR $
Technology Fee $
'1. on
Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $ / (+'7 • COD
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: 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 an. ` ction fee will he charged.
splISP;401
The foregoing instrument was ackn .r CEL •, ,h • ent was acknowledged before me this L'®
day of itZ, , 20 L , by , day of AZ V , 20 ! / , by
Signature
(DO
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires
Contractor
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
A
4111bAr-e.
sT >.
My Commission Expires:
•• xw,t W WY. x x x Y. * * ** C W VWW»C) Wxx *W Wxx W x *xx * * ** *** *xxx W Y.xxx * * ** * * * * *x x Y. x x x x x xx Y. x * %x x x WY.xx;
APPLICATION APPROVED BY:
(Revised 02 /08/06)
/ y,e-'U/-42.27
VALTY RAYMORE
MY COMMISSION #1)1)888914
:
Fl. Not:ry Discount Assoc. Co.
** ** * *** *xxxxxrxx **
Plans Examiner
Engineer
Zoning