ELC-13-101 (2) y
✓ Miami Shores Village
jAN 1 a 2013 i
Building Department �r R
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fag:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No. fi / �
PERMIT APPLICATION Master Permit No. CC--`,- r - 7 6 t�`
Permit Type: BUILDING ROOFING
JOB ADDRESS: Soo M. E. 2 yo i9 v e, M146� V '°
City: Miami Shores County: Miami Dade Zip: 3 3 1 6 1
Folio/Parcel#:
Is the Building Historically Designated:Yes NO vl-' Flood Zone:
OWNER:Name(Fee Simple Titleholder):Barry University Phone#: 305- MI-3000
Address: It 30 0 N 6 �2jv o A vE
City: t V(A n l 514'o A C S State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Etech electric inc Phone#: 3058889331
Address: 7230 NW 66 ST
City: Miami State: FL Zip: 33166
Qualifier Name: Juan Rosello Phone#: 3058889331
State Certification or Registration#: Ec13001661 Certificate of Competency#:
Contact Phone#: 7868450039 Email Address: andrew @etechelectdc.com
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ 61 o 0® Square/Linear Footage of Work: to 01EVtc gs
Type of Work: ❑Addition IJAlteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: 1-OW V o LT A a E ®r- CA 1' 4C
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Color thru tile:
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Submittal Fee$ Permit Fee$ /P®"PO CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW UED $
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."
I
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 nd a reinspection fee will be charged.
Signature Signature
Owner or Agent r ' Contractor
The foregoing instrument was acknowledged before me this The/eoing instrument was acknowledged before me this 13
day of WIZ ,20 I�,by V6 %AAg1►?J- day of mber 20�by Juan Rosello
w1a all known to me or who has produced who is personally known to me or who has produced DAL
As identification and who did take an oath. as identification and who did take an oath.
NOTARY LIC: NOTARY PUBLIC:
EEO 226 9�
EXPIRES
Sign: SJ Sign:of d" s Z 4� 2�.2015 v
Print: Print: Andrew Cardenas
My Commission Expires: `�, l COMIV=0N#lei W My Commission Expires: ''��ci�st►`e�,``
�:November 12,2014
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/1=012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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