FL-13-0159Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
JOB ADDRESS: 41—ey.
FBC 20 10
JAN 29 2013
e.�,
Permit No. �-° 13 — 1:59
Master Permit No. C
Ali'
City: Miami Shores County: Miami Dade Zip: 33/ S ,r'
Folio/Parcelk
Is the Building Historically Designated: Yes NO
OWNER: Name (Fee Simple Titleholder):
Zone:
City:4. s"W" ✓C/ State: /11Z Zip: I 'J1fl
Tenant/Lessee Name: Phone #: ,�D� Z f K 7
Email: ""/ ,? 'C"', -7 !300 Lt
CONTRACTOR: Company Name Phone #: _ Q A . 22,4
Address: riO
City:
Qualifier Me.
State Certification or
Contact Phone#:
DESIGNER:
Phone#•
T
#: !i Certificate of Competency #:
Address:
Value of Work for this Permit: $ �30. w Square/Linear Footage of Work:
Type of Work: DAddress OAlteration ONew jepair/Replace ODemolition
Description of Work: /0 —s / ,OV3
Submittal Fee $ Permit Fee $ Z.5 —4r,7 1 ff-d CCF
Scanning Fee $
Radon Fee $
Notary $ Training/Educatlon Fee $
Double Fee $ Structural Review $
CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $� • J�
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
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will be approved nd a reinspection fee will be charged.
Signa i
Owner or Agent Contractor
The fore oing i trument was ac wledged before me this The foregoing instrument wl!as��acknowledged before me this
day o 20, by �/ day of 201J , by X I�'l��
who is personally known to me or who has produced who is personally known to me or who has produced_
As identification and who did take an oath.
My Commission Expires:
Plans Examiner
as identification and who did take ap oath.
Structural Review Clerk
(Revised 3 /12/2012)($evised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)