DEMO-13-2397Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
�1 "JE
OCT 222013
FBC 20 Lo
Permit No
Master Permit No.
JOB ADDRESS: 430 MG qLI'4 'Sttee jr
City: _ Miami Shores County: Miami Dade Zip: 3g
Folio/Parcelt _ t 1 — 52 Bto .01loop
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder):_ ('\ .15CO ---- atln`if� Phone#:
Address': 1�3C7 &LG 44 S-6'bc .-
City:yr1 iCtryit �(lcsfeS State: Lrcci n Zip: 3313$
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: —C`9[ Phone#:
Address: rZ K- 0'4, <�L'-' n °'TP, -2
City: i State:
Qualifier Name: _ �V'° ($ eru
State Certification or Registration #: cc 3 0 0 1
Contact Phone#: Email Address:
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $_ Square/Linear Footage of Work:
Type of Work: DAddress OAlteration ❑New ORepair/Replace , dlDemolition
Description of Work:
Submittal Fee $ Permit Fee $ / ®P9id v
Scanning Fee $
Radon Fee $
CCF $.
CO/CC $
DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $—��[�_
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. 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 ocpqrs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appy ved spection fee will be charged.
Signature Signature
or Agent — Contractor
The foregoing instrument was acknowledged before me this .2 The foregoing instrument was acknowledged before me this
x
day ofK±&20 -L3 by J� ` •✓I1 day of er , 20 !3, bya►r�Cv �er�2 ,
who is personally known to me or who has produced_ who is personally known to me or who has produced 1D1. *
`�- 66- LK� As identification and who did take an oath. ort �NP as identification and who did take an oath.
NOT
Sign:
Print:
My Commission Expires:
APPROVED BY
Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY
My Commission
EXPIRES:F&r=y07 2017 i
���rnAruuv�i
Zoning
Clerk