EL-12-1873 OCT 0 9 2012
Miami Shores Village M _
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
FBC 20 L�
BUILDING Permit No.j�,' L i —1 4�7-7 5
PERMIT APPLICATION Master Permit No re G -7 7�
Permit Type:Electrical
JOB ADDRESS: l 6 �`1' 7
City: Miami Shores County: Miami Dade Zip: 3 f 3
Folio/Parcel#: // y 3 t B ---I/a
Is the Building Historically Designated:Yes NO `�f H Flood Zone:_
OWNER:Name(Fee Simple Titleholder): �I�
N P r, c�aZZ, Phone#: =
Address: s a7 e=
City: State Zip:
Tenant/Lessee Name: Phone#:
Email: 11 r}11 1
CONTRACTOR:Company Name: AWe- C LPIsic J .�c1p -- ih:o a#'-
Address a C) t Cca Cj
City: h/�'t.cy-ra State:
Qualifier Name: L J!1-2 G Phone#:
State Certification or Registration#. ®2C oCX7'q 2 L Certificate of Competency#:
Contact Phone#: `3��i®y) Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ arr a Square/Linear Footage of Work:
Type of Work: ❑Address Cl'klteration ONew ��OR pair/Replace 0,Dernolition
---- „��
;Description of Work:
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Submittal Fee$ Permit Fee$ XZ',0r_'®5'> CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
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 wil! 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 reinspection fee will be charged.
Signature
Owner,/Agent Contractor
The forego g inwent was acknowledged fore me thi The foregoing instrument was acknowledged before me this
day of �-' ,2011 by ��� J 4e" day of Cc a ,20i by�v YS �SU-Q , ,
who is personally kno l e or who has produced who' rsona y o to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: J
NOT PUBLIC:
L R GOSign: fj n HEN
'4AOO �r COMiA{SSION*EE108885
Print:
1 a C• p TJ�'�' — Print: ,2015
a ;•�•.,% C.RE}0RlGUEZ
My Commission Expires: hRY(X1b4MISSl0t4 DA UEZ My Commission Expires: 66"c,o.d through 1st State Imualtce
EXPIRES:4"i 28,2010
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APPROVED BY / Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
1 -
L-TAX E COUNTY '2'012 LOCAL SUSINESS TAX RECEIPT` 20i3 FIRST-CLASS
CTOR MIAhIWADE CQUN1Y S3ATE CtF ELOA) U.S.POSTAEGE GLER ST PAID
3130 M1�5T�p13PI:AYED AT PLACE"OF BU 9S FL
PURSUAN`f TO COUNTY CODE CHAPTER SA-ART.I t 10 .= PERK NO.231
320694-3 THIS IS NOT A BILL-DO NOT PAY
RENEWAL
BUSINESS NAME I LOCATION RECEIPT NO. 334096-5
ABLE ELECTRIC OF SO FLORIDA INC CC #- 02EO00436
2010 SW 83 CT
33155 UNIN DADE COUNTY
OWNER
ABLE ELECTRIC OF SO FLORIDA INC
Sec.Type of Bushleft WORKER/S
196 ELECTRICAL CONTRACTOR 2
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TAX RECE r.R
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MIAMI FL 33155
PAVIIAW RECEIVED
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140 W.FLAGLER ST. •;
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M"BADE COUNTY�STATE OF FLORIDA 11F
PURSUANT TO COUNTY CODE SEC.10-24 I:
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RECEIPT NO. 30-3340960 CC t�10 z Oi�Qf� 4� _
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SEE BACK OF RECEIP EIEtIALI �IA '
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