EL-08-2183Miami 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
p@ECEWTE
JAN 3 2669 fi
BY:
Permit No.
Master Permit No. `9) ZXx
Permit Type: Electrical
Owner's Name (Fee Simple Titleholder) J7 ,9es'`'' /D��' 6�� Phone # ,9 6 7 c,
Owner's Address / , P� � " -- 5/ e �
n ,�
City , 72 !`' 4hA State 7 Zip
Tenant/Lessee Name Phone # 3 5 7f 6 -I9 2j y
E -MAIL:
Job Address (where the work is being done) j'2---gg''" -.
City Miami Shores Village County
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name
Contractor's Address
City
Qualifier Name
Miami -Dade
Zip
4 r G"--, e Phone # 6 va‘'ed�
State
State Certificate or Registration No. /ziele7 /P77
E -MAIL:
Architect/Engineer's Name (if applicable) Phone #
Zip 3 3/ 6--
Phone #
Certificate of Competency No. '-/P 7�
Value of Work For this Permit $
Type of Work: ❑Addition iteration G M �Nr
El Repair/Replace El Demolition
Describe Work: /CI 7& le—ser Gd 45,19 (00-"--eA
g 1,i ,,1 1eu Crnr. 14/4-0/00 Ala-ti f poira 44,4
Square / Linear Footage Of Work:
***** * * * * ** * * * * ** * * * * *xxxxx ****xxxxx 4a* Fees************* *** ************* *********x*** **
Submittal Fee $ Permit Fee $ "We CCF $ 1400 CO /CC
Notary $ Training /Education Fee $ 3 CO Technology Fee $ ID .(-1O
Scanning $3 `00 Radon $ DPBR $ Zoning $
Bond $ Code Enforcement$ Double Fee $
Structural Review. $ Total Fee Now Due $ 'SO
See Reverse side -+
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. l 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. 1 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 a reinspection fee will be charged
Signature
Owner or Agent ��j
The foregoing instrument was acknowledged before me this T/
day of \. 'g , 20
by i5W'v /yO EJ/1,
who 1 rsonally known to me who has produced
As identification and who did take an oath.
NOTARY PUBLI
Sign:
Print:
• .01./Ps.
da, , DANIEL P. DOWER
MY COMMISSION # DD463852
+OFFe EXPIRES: Aug. 21,2009
J»viei-
My Commission Expires:
P /24lol
*****ww* txxxxx**w***wwxxxiea *** woe *****xaYaY***Xi:**w**xxsevc** cie9exxxxx eY*** x** xxlYxxxxx*xxxxwiriexxaenedexxxxxxxxxxx* x**
la Signature ,� /,� � •
Contractor
The foregoing ng instrument was acknoyKledged before me this 'a7
day of ,20 Del, by )v \1g4o et ,
who is personally known to me or who has produced
as identification and who did take-an oath.
NOTARY PUBLIC:
Sign:
'TEOF FAO
Print: /41 '
My Commission Expires:
RIAM FUNDORA
MY C'I MMISSION # DD 712966
�` • ES: December 30, 2011
gon ThmBud�etNMeryserOces
APPLICATION APPROVED BY:
(Revised 02/08/06)
? 1` i Plans Examiner
Engineer
Zoning