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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)