EL-08-56lk`b \Ot _ I TkiVilLAL
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 r). ' 12,e0 1Q3 Phone #
Owner's Address 2L� 14.1 1_00 J
City rrjigic-v t State J Zip 35)6
Tenant/Lessee Name
E -MAIL:
RECEIVED
JAN 1 0 =y'o
BY:
Permit No. L a' St,
aster Permit No.
Phone #
Job Address (where the work is being done) J`7 )v■ Ito +er {occ,
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Name /14 3
Contractor's Address
City
Qualifier Name
Zip L3 J
NO.
State Certificate or Registrati e No. CC ®J.-- C.76 /Z24)eertificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ ')
�j
®t)
Phone #
Square / Linear Footage Of Work: ' f
Type of Work: ❑Addition ❑Alteration (]New lam' Repair/Replace
El Demolition
Describe Work: R'►,da i 0S " ..CF( )
******** * * ** * * * * *x ** *xxxxxxxxx * * *xxxxxx Feesx *** F**' Y' F' k' k** *wwww**xxxxxx*rr *** * * **** **** **
Submittal Fee $ Permit Fee $
Notary $ Training /Education Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
CCF$
CO /CC
Technology 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. 1 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 $2500, the applicant must
promise in good faith that a copy of the notice sf commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also : tifeed copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven ( er the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspectio arged..
Signature
nature fc#p
ConA' ctor
Owner or Agent
The foregoing instrument was acknowledged before me this .1' The`'. ,t trument was acknowledged b ore me this 1/
day of , 20 �, by tC 10 O , day of ` , 20 o8 , by
who is personally known to me or who has produc
who is personally known to me or who has produced
,bs
As identification and who d'
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
as identification and who did take an oath.
°' "^ MARIE J. CLARK
MY COMMISSION # DD 653890
EXPIRES: July 22, 2011
Bonded 1$�duai8ptary Servkes
NOTAR
Sign:
Print:
My Commis
PUBLIC:
on Expires: Q
r rx xxx xx r. *3:******Icw**** Y****xxxxx xae** ww* lc* xxxxx xxx*************wx********xxxrx Yxxxde six'
APPLICATION APPROVED BY:
(Revised 02/08/06)
*Xxxxxzx *x *x xxxxx *x xxx
Plans Examiner
Engineer
Zoning