EL-12-8510ro n r, r7
Miami Shores Villa e u �� V' y
g MAY 11 N 12
0"Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 A.
Tel: (305) 795.2204 Fax: (305) 756.8972
144�INSPECTION'S PHONE NUMBER: (305) 762.4949
;;o
BUILDIN Permit No.
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple
Address: MIX ® Al 4- q 7 W S t
City: State:
Tenant/Lessee Name: Phone #:
Email: �� --
JOB ADDRESS: 1
�, 9 -7 ro� S
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO
Zone:
CONTRACTOR: Company Name: ILI&4n afo
ief &vl Phone#:
Address: lJ-bM 4le- X6 -
City: 4-A A4 (if ` 1. State: rl Zip: 33 (e
Qualifier Name: A 0 4lPC43 JQ'• b L-✓ Phone#: 301 ^ iNi —/19/
State Certification or Registration #: 00 3d°f Certificate of Competency #:
Contact Phone#: ;K (I 4� /?y /Email Ad �''� - -P/eL� �C (� e7`''j7 9,f ,
DESIGNER: Architect/Engineer: /� x� Phone#: , �i3' "�� 0 4
Valve of Work for this Permit: $ 14A✓.- a Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work:
Submittal Fee
Scanning Fee $
Permit Fee $ 1JX_1P "0 ® CCF $ CO /CC $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Leftr'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. 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 Signature Qeu G✓, ----
Owner or Agent ,/� Contractor
The foregoing instrument was ac o ledged before m�this
day oft e�, 20 �bY . a �f -I-Q— t' ,6) 6�
who ' personally known to me or who has produced
As identification and who did take an oath.
NOTARY
Sign:
Print:
The foregoing instrument was acknowledged before me this�
day of � , 2012 , by fj e
w known t e or who has produced
as identification and who did take an oath.
NOTARY
Sign:
Print:
�,�. v,e• .. vue.0 i. -.� ni re Vd' SLVL41Lt1
My Commission Expire : f E 8138 My o ssion Expi* ' 0ubo t Pierre
'< :0 €ICSDD783726
My Mm. expires Apr. 5, 2015 `' Ealrirns: APR. 29, 2012
P.^ OED THRU ATJX47IC BONDMG CO., INC.
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APPROVED BY 2,1M41AY _ Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)