EL-08-1633M
DING
I
Miami Soo 'es Villag
A4 i
• nE", 0 4-
Building
n
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e
art
g, p ment
Tel: (305) 795.2e, Mla 1 Shores, Florida 3313 El) Y.. 1V_L ---------
0050 N.E.2nd Avenue,
204 Fa x1 (305) 756.8972
Per it No.�
CATION Master Per it Na4-6NO
"` �
FBC 21104
Permit YP e:
El ' ctricaT
Owner's ame (Fee Si ple Titleholder)' � F—P ki-
Owner's address 3 N Uri R L ST.
City—hk—1 A- State �t-
Tenant/Le see Name
E -MAIL; ' CS ILL (D WS v 1,1
Job Addr ss (where the work is being done) �� A
City Miami Shores Village County
FOLIO / ARCEL #
Is Buildin Historically Designated YES NO_
Contract is Company ame /1 %�" '440-eTi��s�
,. �. ... ..
city —24
Qualifier
State Cer
E -MAIL
Architec
Value of
Type of 1
Describe
State
tU-t Phone# —7 8(0- Z. 00D`1rj
Zip `
Phone #
F.E.
Zip=
lone #
3�
e or Registration No. ertificate of Competene, No.�����%��� .
ineer's Nairne (if applicable) Phone #
4
I
c For this Permit $ Square /Linear Footage if Work:.
❑IA8dition ❑Alteration ❑Ne ❑ Rep ir/Replac
Submittal Fee $ Permit Fee $
Notary $ Training /Education Fee $_
Scanning Radon $
Bond $ Code Enforcement $
Structury I Review. $
sass �ed¢drssss ssaexssssxssxssxss ssx � asdrxsk ssss ssssssxssss #ss ssxss ssxxss
CCF $ CO /CC
Technolo Fee $
BR $ Zoning $
Double Fee $
Total Fee Now D Lie $
See Reversel�'�ide —�
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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. 1 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 bu C 1 es ated value exceeding $2500, the applicant must
promise in good faith that a co o the is
P b' i copy f notice of commencement and construction ien law brochure will be, delivere he person
whose property is subject to attachment. Also, a certified copy of the recorded notice of cotta en a must I ted the job site
for the first inspection which occurs seven (7) days after the building permit is issue a ence of ch ted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature
The
day
Sign:
Print:
"_J��
Owner or Agent
ment�was owled/ ied befo this
20 h) (bvi kk& i • .
oivn to me or who has produced_T I M
Signature.
The
day
who
identification and who did take an oath. , )/
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02 /08/06)
Sign:
Print:
My C
X_ Contractor '1
Wt was acknowl ge befor m this 4
2OaKby
raknown t me or who has produ
ce and who did take an oath.
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Plans Examiner
Engineer
Zoning