EL-10-2044Miami .Shares 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
NOV 1 6 2010
Permit No. l 0 --9044—
g0
,44(10
0 0.
Master Permit No.
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder)jL1. 1 L 1r.S� S f/ANYSPhone #
Owner's Address 13 P (-k- < f
City lAk ekK \ S fr (Z T5 State P-Z- Zip i
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) Sif,,' '`-'
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # tj•'?2-36 COI - 0145,0
Is Building Historically Designated YES NO
Contractor's Company Namec Ct,f2C1Q-kC,-
Contractor's Address ‘Z$O.'S
City W■A)TAAA
Qualifier Name (SLd
State Certificate or Registration No.
E -MAIL:
' '1, . 2d''reg--2
State Fe--
tEL
Zip S'�
Phone # (301) s _J ' ?OZ
Zip 33
Phone #
Certificate of Competency No.
Architect/Engineer's Name (if applicable)
Value of Work For this Permit S4rpcR�
Type of Work:
Describe Work:
Phone # 3 6 S 5 2-6. '3 6 3-7
Square / Linear Footage Of Work: C L
❑Addition ❑Alteration ❑New ❑ Repair /Replace
G G cc C 2 /CJSIJ M ?7i
❑ Demolition
Submittal Fee $
Notary $
Scanning $
* * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
e $f®lal ''cir -57
cation Fee $
DPBR
CCF $ CO /CC
Technology Fee $
Zoning $
Bond $ e Enforcement $ Double Fee $
Structural Review. $
Total Fee Now Due $
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 suchh posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent Contractor
The foregoin instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 0,4 , 20(0 , by , day of ■ , 20 1j , by
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:
Print:
My Commission Ex�����, Expos: MAR. 10, 2012
'SOAIJED TM ATLANTIC BONDING CO., INC.
***************'** * ** * ** * * * * ** * * * * * * * * * * ** * * * ** **
APPLICATION APPROVED BY:
(Revised 02/08/06)
°''s Dolores Lopez
My Commiss ,,6 ;Expos: M��0,
* * * * * * * * * * * * * * * * * * * * * * **
.nog CBONDINGCO.,iw.
Plans Examiner
Engineer
Zoning