EL-14-236Miami 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
FBC 20
FEB 0 6 2014
Permit No.
Master Permit No.,g/�%�
JOB ADDRESS: rzb0 Ize CAB G-� .
City: Miami Shores County: Miami Dade Zip: '3 3 % 3Q)
Folio/Parcel#: kt-3205 — 0oc, — n320
Is the Building Historically Designated: Yes NO 10 Flood Zone: At=
OWNER: Name (Fee Simple Titleholder): J*;%S&a C,,qom Phone#: 30S •333 . S4%'%
City: lkaw.t <'Vocues
State: - (—
Zip: 33\353
Tenant/Lessee Name:
Phone#:
Email: `.���n ®�c a no •m�M
(gyp aro. Cont
CONTRACTOR: Company Name: _ E
�'y`""� "�ti
c7twiCes, ��e •
Phone#:
7:V&,. _L-b%t¢IJ8
Address: }3SS SW rbc\ S�
City: K; even;
State: V- L
Zip: 33l S-16
Qualifier Name:. Cttw�jum6 &4y0m
Phone#:
�r$Fo•2�+5.1Q�0�
State Certification or Registration #: SL 13 Ot7 S \ 3
Certificate of Competency #:
Contact Phone#:
Email Address:
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DESIGNER: Architect/Engineer: Fe40c-ndo
gQaN"
;?E W SINN 1Phone#:
4''6(0.3843. glSc-1
Value of Work for 'this Permit: $ __$ 00.CQ Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration Tew ❑Repair/Replace ❑Demolition
Description of Work: CkerJrvZ Lc.k
Submittal Fee $ y!�Q .6 D Permit Fee $ A O, a ® CCF
Scanning Fee $
Notary $
Radon Fee $
Training/Education Fee $
Double Fee $ Structural Review $
CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable) _
Bonding Company's Address
City State
t1
Mortgage Lender's Name fit -applicable)
Mortgage Lender's Address
City
to
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 recordedof commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building 't ' ed. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be char IV
c
Signature Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 3 The foregoing instrument was acknowledged before me this -3
day of F� , 20 )4 , by 'Qc CAQ C -Io r�3 day of F� , 20 ``1, by LX -L Kg,%Jq� ,
-01
who is personknown to me or who has produced who is p MQuaU *+own to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission
RIEL E 4UAMAV
11-11 S..... # FF6S0887—
EXPIRES: JUIy 4, 2017
Bonded Ttn icy Pubs Undembrs
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My
TNN MM POW Underw bm
�� ly
APPROVED BY JAS Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)