EL-10-1321Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: ELECTRICAL
PROMV3fil
jUL 9016 Vi
•.P
Permit No. — 3•21
Master Permit No. C i 0
Owner's Name (Fee Simple Titleholder) @ V'\ r"•\( -4..m 4"- Phone # ?)05 -75 g Sa
Owner's Address (DP ti CO l (: ` 4.
City k in i S ( orr. State V ` Zip
Tenant/Lessee Name
Email
Job Address (where the work is being done)
CD
Phone #
06 ,*
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # t - l — 00 e) sue- CD
Is Building Historically Designated YES NO Flood Zone
Contractor's Company Name Ae \IaS° v.G q Phone #
Contractor's Address (aOC') �-� ,r ,> ��- L-1 \ 1
City -" r _ tat Zip JJI 0
Qualifier Name GLX U .Orr' c ass `®v`S c5 Phone # Fj -3115 - 3 ( cj -
State Certificate or Registration N
Contact Phone 306 - 7 56
Architect/Engineer's Name (if applicable)
E -mail
Certificate of Competency No.
Phone #
1. 6/925
Value of Work For this Permit $ �Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration l eW ❑ Repair/Replace
Describe Work: Pr v P Q
a ;
250
❑ Demolition
00(c„
********* *,* * * ** * * * * *** * * * ** * * *** * ** * *** Fees, ************ ** * ***** * * ** * * * * * **** ** ** * ** * *x
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date:
Technology Fee $
Bond $
Structural Review. $ Total Fee Now Due $
See Reverse side -,
Bonding Company's Name (if applicable) 1t% [,
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) 4% (,2
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 ap ed and a re- inspection fee will be charged.
Signa
Signature
gent Contractor
The foregoing instrument was acknowledged before me this / Co The foregoing instrument was acknowledged before me this /4
day of Jet , 20 to , by C AM/ s (9m, Al , day of 34 , 20 70, by at, mat a wa .s 4to asp,
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 PUBLI : NOTARY PUBLIC:
Sign:
Print:
My Commission Expire
RiChARD M. MALCY
MY COMMISSION #D0831707
EXPIRES: OCT 16, 2012
Bonded through 1st State Insurance
Sign:
Print:
My Commiss
RICHARD M. MALCY
MY COMMISSION #00831707
s: EXPIRES: OCT 16, 2012
Bonded through 1st State Insurance
*********** *** * * * ** * *** * * * * * * * * * ** * * ** * * *, *** * * *** * * * * ** * ** ** ter * *** * * * * * * * * ** *** ** ** ** * **** * * * * * * ** ** ****
APPROVED BY Plans Examiner Zoning
Engineer Clerk checked
(Revised 07 /10 /07)(Revised 06/10/2009)
Miami Shore Village
pz
Building Department
x:0050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795,2204 Fax: (305) 756.8972
CTION'S PHONE NUMBER; (305) 762,4949
BUILDING
PERMIT A
FBC 20
Permit No
aster Permit No. �;-
Permit Type: BUILDING ROOM
Owner's Name (Fee Simple Titleholder) vv
Owner's Address
City
Tenant/Lessee Name..
Phone #
,Job Address::: the work is being done).
City Miami Shores Villaee County Miami
FOLIO 1 PARCEL # \ t — , ( a`:: — c;�;:i) --
Is Building Historically Designated YES
lood Zon
Phone
Value of Work For this Permit $
Type of Work: DAddition
Describe Work:
Demolition
isn k *k;4kx *9 ;$ 4 k°-k "; *�!
** ***ic**** ** * *K-`_ ^:. s: 'n` ****A*);.
Permit Fee $
COICC $
Training /Edu6
Scanning $ adon $
Double Fee $ Violation date:
DPf3'R
Structural Review. S
Bonding Company's Name (i f applica
Bon Company's Address
City
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 AFAVIT: I certi
tl the foregoing ion is accurate and that all work will be :done in compliance with all
applicabl� ii,ws regulating constructip» and zoning.
�.4
"WARNING TO OWNER: YOUR FAII:,UR. TO RECORD 'A NOTICE OF
COMMENCEMENT MAY RESULT IN 1 YOUR PAYING . TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU IN'-ND: TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTO BE1ORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notiee to .Applicant: As 0 condition to the is. nilding permit with an estimated value. exceeding. $2.500 the appli a
protr in good friith that` a Copy of the nonce of commencnient and cofstruttiofl Beni law broohure will be delivered to the person
whose'property, is subject to 'attachment. •r,;, a certified copy of the. recorded notice of comme tcement must:
for the first Irt pc be.a ht h oc u r s sin. a y s a er:the b u i l d i n g . p e r m i t issue :.in the abbe ,f h posted notice, the
fee *ill be
rusted at the job site
w ie c.
The fore of g instrument was acknowledged be fore t e this 1 S
cc
day of ,2010 ,by.3l LroiN - -I
:..••sw.
istho its personally known to me or who has produced who is persona y known to me or who roduced ____
As identification and who did take an oath.
Signature pContractor
Th - regoi ' instrument was acknowledged before me thisi
day_ i 2WjQ,bP\ -- O _i_`SCLL/(. -C: �t2 CAE
NOTARY PUI3L1C:
rl ; �1306{7GIA
c t✓L l�LilrtiYcom
Print:
My Commission Expires:
as identification and who di
Uba!i
DD67 &159
Y20,2011
Ycont
Print:
My Commission Expires:
isic*:*-;,. .k**;;*********- ;`;;i;h•:i::Cat *,,:** ;r*'h * *7.i******:+A-: k*-:f** *i :* * *k*****k***k:l A—,i* - A- :4** * -A :***k%rk:',i; -kT1..
flans Exainineri
Mv fr-
(111 AA; glIv2 1PC, aW-P
M 1 4-04:( Oe,rt/. IPCMEWM
la APR 1 5 2013
BY:
eCro4± # FL.- -7 -iPi 3 zl AE„- 1013 2z)
oz, 442
10,FL,r4-
11;6 ; 6*.t71(i et_