EL-11-531 1 1t Lr lyn4tp Miami Shores Village
• MAR 2 5 2011
Building Department �',
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 5 Y
Tel:(305)795.2204 Fax:(305)756.8972
BUILDING Permit No.EJ —531
PERMIT APPLICATION Master Permit NE_
FBC 2004
Permit Type: Electrical
Owner's Name(Fee Simple Titleholder) "MAVIFF L11VV— SutUE(L Phone#
Owner's Address ND I
Citym unvil 1 5Ndk*A State 4-1 Zip 33 t 5-5
Tenant/Lessee Name Phone#
E-MAIL:
Job Address(where the work is being done)
City Miami Shores Village County Miami-Dade Zip 3313$
FOLIO/PARCEL# 11 —3205— 0240'
Is Building Historically Designated YES NO— 00,'
Contractor's Company Name 4--...* 1GPhone#C/CJy •�Z,� '�0�
Contractor's Aftess '
1
City State Zip 3 7R/-1,P
Qualifier Name Phone# � 1 12 9•—j
State Certificate or Registration No.", 1��+Certificate of Competency No.
E-'MAIL=
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Perdkit$ Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace 'Demolirion
Describe Work: r(�IYJ,I� �6--r,7.,
Submittal Fee$ Permit Fee$ /&O e V CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
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
0 i 1
Signature Signature
Y
Owner br Agent Contractor-
The foregoing instrument was acknowledged before me this, ,,The foregoing instrument was'ackmowg �efjor m this.Z.s
day of 20!I by C)Qe te- day o'f_, 20�,b
y
who is sonally ow me or who has produced who is personally known tome or who has produced
As identification and who did take an oath. ez,, as identification and who did take an oath.
NOTARY PUB I DAVID BRADLEY NOTAR . PUBLIC: @+
COMMISSION#EE041839
it �6
November 15,2014 til
Sign: Sign: 3
Print: Print: ��• S�oO ,•�4s
My Commission Expires: 7 — My Commission Expires: .a;2 01 �,•""'�G®���`
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APPLICATION APPROVED BY. Z., , Plans Examiner
Engineer
Zoning
(Revised 02/08/06)