EL-11-1248 Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972
BUILDING
Permit No. �' �''►U
PERMIT APPLICATION Master Permit No — `a
FBC 2004
Permit Type: Electrical �Q{�
Owner's Name(Fee Simple Titleholder) � � uwcs /�'C�l'LE,� Phone#
Owner's Address 14461 /✓E /4762 �7'•
City ,V/.fi I S ,ems State - Zip 33/3
Tenant/Lessee Name Phone#
E-MAIL:
Job Address(where the work is being done) 4/4
City Miami Shores Village County Miami-Dade Zip 3 /3
FOLIO/PARCEL 0 /I 40/4140
Is Building Historically Designated YES NO
Contractor's Company Name 1::7 45k�,*PCIOyw- Phone# X86 07/J00
Contractor's Address 1X V 0/ eZleST e6 .
City A,4445�9 4'��lrel� /S State /zl- Zip 35-� ®/&
Qualifier Name �yPtS�o /�gir/ L Phone# 794-'07 QS— 7w /JV
State Certificate or Registration No.ECl3G4 07779 Certificate of Competency No.
E-MAI39drf ,Aa —
Architect/Engineer's Name(if applicable),CEAI•412F Iv Phone#,7*6 4 3-5-
Value
5 Value of Work For this Permit$ 74040•40
Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration gNew ❑ Repair/Replace
Z� El Demolition
Describe Work: If/E�/ �OOL- EZT.E'� L /sir- 1.4,4
Fees***r,i;****i:icr.******ie*ic
Submittal Fee$ Permit Fee$ 3m® 'e-p o CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon $ DPBR$ Zoning$
Bond $ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ L
See Reverse side
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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 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 �� i
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this %/ The foregoing instrument was acknowledged before me this
day of %27-4y ,201t ,by-� yE�iY� Yv�[E� day of •Ayc I' ,20 //, by F�.4,rK,�Sc�� T/.��it►iL2
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: S ign:
Print:
Print: ��i4
My Commission Expires: My Commission Expires:
******************** x'gtC'iRhA*P': F ib* ************************• • **4LORM 44ALEONSO
My COMMISSION#EE046674 '_ My COMMISSION.#EE046674
EXPIRES December 06,2014 EXPIRES Dewmber 06.2014••, ,••'
APPLICATION APPROVE "153 •da Je�rvice,eom �
Engineer
Zoning
(Revised 02/08/06)