EL-13-2330 - � . Miami Shores Village
g OCT 11 2013
Building Department BY: -
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.L J "c
PERAW APPLICATION Master Permit No.?,(
Permit Type: Electrical
JOB ADDRESS: '- 0 ,54L2
City: Miami Shores County: Miami Dade Zip: 313/1
Folio/Parcel#: i —7? _0 00-70
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): k#tN oa V,�,S- -77 7C?
Address•
City: -eG State: Zip; 331,3e
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: � C� ,G � I P'—CPhone#c7 --S�'-0 2�
Address: �P- _ X o!2)/if Z5' Af l 1--e— 0& f
city: zip. 4-73a2_61 >
Qfi Phone#:
State C�nX`�18is
of ®� Certificate of Competency
L�11llYR%L Wl1Gfi: 1 � . Rk . .,,. - °�• �C` a ._ __
a Email Address:
DESIGNER:Architect/Engineer.-A4 Phone#• eo _ ,57o3 0
Value of Murkfore Pert~ ' g
quare/1"ear Footage of Work:
Type of Work: UAddress DAlteration Tev v. : WRepair/Replace. ODemolition
Description of Work:
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Submittal Fee$ c I ��� Permit Fee$ 2;;i-,00" CCF$ CO/CC$ .
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
Bduding Company's Name(if applicable)
Bonding Company's Address
City State zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State 7p
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
or gent Contractor
I,
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this—A
day of &� 2013 by Ar��l�d� ]: �l�- }lne�� �day of
a TfRESA R�-
who is personally known to me or who has produced who is ���•� t � c
As identification and who did take an oath. ' s ffficatibn With gdid an oath.
NOTARY PUBLIC: N Y•PUBLIC:-
Si (J— " FSA
Print: CLY l� ? r
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aBnugry� �.h•`: Ii1SS1 II r c �Q•�c
My Commission Expires: :�'n M.PUM Ano�ission�acpixes�
rmrcor01HE12795
EXPIRES:September 7,2015
Bonded Thru No"Publt Underwdt m
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APPROVED BYl ./� OPS plans Examiner Zoning
Structural Review Clerk
(Revised 3/112012)(RoAsed 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)