Loading...
EL-13-497Miami Shores Village Building Departmentc: u 1 226 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUILDING Permit No. PERMIT APPLICATION A" Master Permit No. J� Permit Type: Electrical JOB ADDRESS: %�a City: Miami Shores County: Miami Dade Zip: / �2 Folio/Parcel#: // S.2 (55 -31 206-67 Is the Building Historically Designated: Yes OWNER: Name (Fee Simple State:City:/.i NO Flood Zone: TenandUssee Name: Phonek Email: CONTRACTOR: Company Na 6— pe" 0000 Phone#: sys �7 � �'��/ o3 Address: V �U City: L_,, State: Qualifier Name: //, r PJ ✓L Phone#: CS -1 7160 State Certification or Registration C� �% � Certificate of Competency: Contact Phone#: Email Address: ru 6)1'4 e- e 4 , u? DESIGNER: Architect/Engineen Value of Work for this Permit: $ l�l�J SquarelLinear Footage of Work: Type of Work: OAddress DAlteration of Work: LlNew ORepair/Replace ODemolition Submittal Fee $ Permit Fee $ 4E --y 1010 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Doable Fee $ Structural Review $ TOTAL FEE NOW DUE $l 1,v 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 y of the notice of commencement and construction lien law brochure will be delivered to the person whose property is sub' attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspe w occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will t oyed and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this day, of 2011, by CkIXIS S avtli who s perso���nally kn' o to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Si —_r—JAY S GOLDMAN Notary Public - State of Florida My Comm. Expires May 1.. 2015 iloaded Thmullb National Signature i. ` Contractor The foXvo,", g instrpinent was acknowledged before me this day of' , 20% —, by Co --bare 64rei'q , wh rsonally known me or who has produced as identification and who did take an oath. Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06110/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: My Commission Zoning Clerk