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DEMO-11-959 (3)Aug 011 03:33p BBF Construction 305 - 234 -4515 p.3 Miami Shores Village Building Department 10050 N.E2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 INSPECT'ION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATI ©N FBC 20 AUG 1 7 2011 Permit No.D\ 0 f (i° Master Permit O rto(l ° Ct Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): 1„) LL ,,, Phone#,'- 1i1-' 111 Address: co on N. atU. rive City: r-P. State: F L. zip: ?5'313$ Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 01501 ~ q 5t\ 5 N. E_ ()Hilo_. City: Mandl 4hores fiCooimry: Miami Dade Zip: 3'J `3 ? Falio/ParceL#: Vi + ' aotQ .. (fib " 3"t UV Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 1 A� a- t zrrz. L L 1 C C. phone# `�� 1 �°� 375 Address: i 10 0 3 i ert ikkio= City: a il o i e f &i. State: Et-- Zip: 3` 50 Z 9 Quidifier Name: R0 a T- . g'®c^- 1c, Phon.e#: 9411 Z La r s-156,6 State Certification or R on #t: l; L L 3 Z- ci0 0.4 Z- Certificate of Competency #: Contact 7583 7514 Email Address: rei C e l e c-�r► C. g :O SA ' Coer) glitter: itA, Awl C% "e 6t� U`- Phone#: s Z8 a10'3 7 Value of Work for this Peru: $ P9(9 Square/Linear Footage of Work: Type of Work. DAddress QAlteration QNew QRepair/Replaoe *Demolition Description of Worla ► ;;,I, a v-- f l Avv fk_. * Baas **.sa *******ss ****s *aa* **a t s* a sx * * *4 Submittal Fee $ Permit Fee $ 7 ®' f3 45 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ TraQdng/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL 17 h, NOW DUE $ Aug 0 11 03:33p BBF Construction 305 - 234 -4515 p.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 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 can on 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 t Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first en (7) days after the building permit is issued In the absence of such posted nonce, the inspection will , , l Lri l and a r; l 7,' will be charged Owner or Agent The f ; , _ !' it was acknowledged before me this /0 — day of ,20 / /.by ere z4 e min/ who is personally known to m3 ,41r who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print 6" n t/ ;e- NoTikf?t PilbLIC.S`tATE OFFLORIDA Yaniv Offr Commission #DD795680 Expires: AUG. 22, 2012 My Commission Expires: APPROVED BY Signature Contractor t was acknowledwaA before nie is 0 , 2 0 /f , b y 1/ r known to me or who bas produced The foregoer day of who is NO Si Print identification and who did take an oath. I ; My Coiimiissipn *.MYCOIe M IISSIION DD sr 'h EXPIRES: March 8 2013 4406*** ********* ******8* ***** *f*****# *f** *�* **** flans Examiner Structural Review (Revised 07 /10107)(Revised 06110t2009)(RevIsal 3I15t09) Zoning Clerk