EL-13-2209Miami Shores Village
Building Department
90050 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
JOB ADDRESS: 9301 N 13"SHORE DR
FBC 20
®Cr 012013
Permit No. I-,/ L - 2?,2W
Master Permit Nok 13 _ 97
City: Miami Shores County: Miami Dade Zip:
Foliornarcel#: 11-3205-027-0560
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Guy Kurlandski Phone#: 305.297.0803
Address: 9301 N Bayshore Dr
City:
Miami Shores state: FL zip: 33138
Tenant/Lessee Name: Phone#:
Email: guykuriandski@hotmail.com
CONTRACTOR: Company Name: -3-a-- 1&/-0 104e? -- r C Phone#: -TO -f 6 -�O + � q
Address: _ --�=/� 6 &---"—® /i�-tr!®
City: �" '� `' State: O Vii' � zi
Qualifier Name:Phone#-3046'a--�0"Z-45~1Z,'P
State Certification or Registration #: —fe—f I.FC OI -P 70 Certificate of Competency #:
Contact Phone#: 7 (Z v"'_ Email Address: dOv ®l
DESIGNER: Architect/Engineer: Markt Campbell Phone#: 305.528.3037
Value of Work for this Permit: $ 3?j Square/Linear Footage of Work:
Type of Work: ❑Address EfAlteration ❑New DRepair/Replace DDemolition
Description of Work: 1'�&i� (E--tAc CeA C,,kL w `. N'� ?Z7� P ur�f S� � .
Submittal Fee $—SC Permit Fee $ �i �'�° ®� CCF $ CO/CC $
Scanning Fee $
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 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.
"WARMING TO OWNER:
COMMENCEMENT MAY
YOUR FAILURE TO RECORD A NOTICE OF
RESULT IN
IMPROVEMENTS TO YOUR PROPERTY.
YOUR PAYING TWICE FOR
IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Noiice 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. sence of such posted notice, the
inspection will not be appy ved and a reinspection fee will be charged.
/
Signature
�+ Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 1 The fore ment was acknowledged before me this Lr' a
day of , 20 I'S, by 0- i ff JMd Sk a day of 20 _, by LV
who ispersonally known 9 me or who has produced who is ersonally known to �e or who has produced
As identification and who did take an oath. as identification and who did take an oath.
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
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