EL-08-1402Miami 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)
Owner's Address 156 fli UO q 5
City ► V `) km) 44-1-ceEs State f
Tenant/Lessee Name
E -MAIL:
Permit No.
Master Permit No.
Job Address (where the work is being done) J 8
City Miami Shores Village County Mia '� ade Zip
FOLIO / PARCEL #
Is Building Historically Designated
YES
NO
Contractor's Company Name MOO
Contractor's Address
City
Qualifier Name 2-6
State Certificate or Registration No.
E -MA L:
Phone # 36S— 75g—a360
Zip 3"3%56
Phone #
Certificate of Competency No.
Ark itect/En_ 's Name
Phone #
V.rue of Work For this Permit / {°
Square / Linear Footage Of Work:
Ty s of Work: ❑Addition i ❑Alteration [(New El/Repair/Replace /
rr❑Demolition
Descr t Work: f/1 � l ` � � l ° if 5//4,
d: 9:* at9es49exxxxx********nheYdrne** ************ Fees************* *x 9eoYeY*x a4 ****nY*****xsYdrdc****akaa:xx
Submittal Fee $ Permit Fee $ CCF $
Notary $ Training /Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
CO /CC
Bond $ Code Enforcement $ Double 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
Sta
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 separatepermit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACE BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT :;:tee at all the foregoing information is accurate and that all work will be done in compliance with all
a pp licable laws e g
aiating-constructi )and Wining.
"WARNING TO OWNER M ' FAILURE TO RECORD ANOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR('ROV MENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YO . ' ;:A,► DE ; -; OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant.- a- condition to the i nce of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of-tt dice of commencement and construction lien law brochure will be delivered to the person
whose property is subjeattzr mcent. Also, «certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) d s. s after the building permit is issued In the absence of such posted notice, the
inspection will not be approved and e ,rei, spection ee will be charged'
Signature
Owner or A
The foregoing iDstrunient was acknowledged
day of W 0 t , by V
Contractor _
The for .oing instrument wag acknowledged before me this
day of % ill: , 204 , by -J46 1
who is perso
who is personally known to me or who has pro
As ide , i :. n and wg Aliffrake an oa�ht
�NriT 4y .
NOTARY PUBLIC:
Sig
Print:
My Commission Expires:
Ily known to me or who as produced
as. identificatio � %n j . did take an oath.
NOTARY `PUBLIC Si °'
,�. .-.
Sign:
rint:
Commission Expires:
*** ***** &**x******* ************* **
APPLICATION APPROVED BY
(Revised 02/08/06)
.$®�e."1'lans Examiner
Engineer
Zoning