EL-10-1877Miami 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 Titleholpr)
Owner's Address 1 1 5. NA.E.
City k'k iCtrC k ID DC73State
Tenant/Lessee Name
t vlo__
T T2 ir-eze
achn
Permit
0 m a 7 Tf- 77
OCT 25 i,ui01)
Master Permit Notee 0- g--)
Phone it 1e)(4,- 37L4- 1)\ I
Zip 43'3'13 Ch
Phone #
E -MAIL: deg/5i a 0 p) act . aorn
Job Address (where the work is being done) I [Irt)
City
Miami Shores Village County
FOLIO / PARCEL # -59-015 -001-0
Is Building Historically Designated YES
Miami-Dade
6110e-
Tan--ace-
Zip TI3c 6
Contractor's Company Name 1- (3 on -F, V° uk CC , 5er P
Contractor's Address
City Li C'i e State
ilk i •
■ AI. •
Qualifier Name
State Certificate or Registration No. E
E-MAIL:
-600$
3O3
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work:
Describe Work:
Zip
Phone #
547+ —0009
Certificate of Competency No.
phone #c5f-t ei 5 (
Linear Footage Of Work:
['Addition ['Alteration
(cc-vcc..■ \AO ok-v
ce 0 Demolition
** **** * *Fees w **.* w xxxwww*,”<*wwww*wwwwwwwwwwwwwwww
Submittal Fee $ OD' Permit Fee $
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Bond $
CCF $
Technology Fee $
Zoning $
Structural Review. $
Code Enforcement $
Double Fee $
CO/CC
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 such posted notice, the
inspection will not be approved and a reinspec ion fee will be charged.
Signature ��� Signature
Owner or A
The foregoing instrument was acknowl
C', %'tra or
oregoing instrument was ackn s ledged before me this a,2
day of , 20 by day of l G , 2010, by R` -acre! rVAj dQ(d„.J 1
who is personally known to me or . as produced who is personally known to me or who has produced 1
As identification and who did take an oath. as identification and who did take an oath.
ROBIN E HUGLI
NoteryPut> - State of Florida
Commission # DD7
MY Commission Expires
June 1,2018
NOTARY PUBLIC•
Sign:
Print:
C
CRRMEd ASIAN
MYCOMMISSION # DD 101162
EXPIRES:JeOS 20,2013
Bided Its Mgr N y S
My Commission Expires:
**w xxxxxxxxx x**xx x***xxx*x**c &a ***** x****Ic do x** xxxx x**xx
NOTARY PUBLIC:
Sig
rint:
My
xpires:
0) latAi
.ac* *** xx*xxx * xxxx xxx xx xxxx,*Y.
APPLICATION APPROVED BY: ��� /� Plans Examiner
Engineer
Zoning
(Revised 02/08/06)