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UL. 0 ll 2010 B �lchng Departmentnt 10050 N.B.2nd Avenue,Miami Shares,Florida 33138 yY, Telt(305)795.2204 Fax.(305)736.8972 INSPECTION'S PHONE NUMBER:(30.4Q.762.4'949 _BUILDING Permit N..' Z tQ—128 PERMIT APPLICATION Master Permit No. i FBC 20 Permit Type:ELECTRICAL ee Simple Titleholder) X6 CC- r ._. _ Owner's Address f��� dtJ`r✓" 2��,' < State �, p TenanV1A=ee Name d Phone# Email v � Ir1`r � o6-11 Job AddreS(where the wank is being done) t LIS— A) Z6eS! City Mimi Shores Village CountyMiami-Dade Zip '3 ) FOLIO/PARCEL# I �G o N - Is Building Historically Designated YES_ Flood Zone ACE Gonane ":tb CgmpaayNameItcho �P v Phone# Contractor's _ O L Ci — Statep � � Qualifier Name �Q_ri�a��?X"nnn. .� Phone# State Certificate or Registration No. r,r (�`j( Certificate of Competency No. Contact Phone '' LSI E-mail Architeat/Engineer's Name(if applicable) '7i G!{� ' (!/a-�/�� Phone# j Value of Work For thts Permit$ 2-00-0 Square/Linear Footage Of Work: Type of Work: QAddition Alteration bit w ❑ Repair/Replace []Demolition Describe Work; S/6 J L l v r�-? ✓/ �Z� P,�/ 1/b , . �' -1�1C �` .` i �*+a,i�,x,�*,�,�,ra*w�,r*�a***,��+wr�r�wa�,�w+i�,�+tt,�F ��,��*,k�a*,�,w�a,�*�,��,wa,rs►�+t��r,�,v,�,a*�,�,�**+a,��r�,�,t Submittal Fee$ Permit Fee$ — CCF$ +C©/CC ''Papa n Notary$ Training/Education Fee$ ]- .! TecbAology Fee.$ Scanning$ Radon$ DPBR$ Bond Double Fee$" Violation date: Structural Review.$ Total Fee'Now Due$_ f Q+ See Reverse side-� I Bonding Company's Naim(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City Stag 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 constr�uetion in this jurisdiction.-I understand-that a.separate-permit-must be-secured-for ELECTRICAL,WMY,PLUM BINGi,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 witlbe 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. . IV YOU INTEND TO OBTAIN FINANCING, CONSULT, WITH YOUR, LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CO]VIMENCEMENT." Notice to Applicant: Asa condition to the:issuance of P. ing permit with an estimated value exceeding$2300, the applicant must promise in good faith that a copy of the notice of.comm gnt and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certifte the recorded notice of commencement must sted at the job site for the first inspection which occurs seven (7) days a ter, ldtng permit is issued. In the abse osted notice, the. inspection will not be approved aWarepAspection fee will birc d Signature _ tore Contractor The fore in ent was wT ged belbre mftth1is this/_ The foregoing. ;cat was aclmowledged before me this day of day of •r+E ,20L*a; ,by 4+e.t�twe. 1F1 amcu who is y own t me who has produced wh is personally known to me or who has produced entification and o did oath, -as identification and who did take an oath - � y r : NOTARY PUBLIC ggqlt6tslititld/ NOTARY PUBLIC •��iS810A •,y ��i $ign: '� • Sign. Print: — N: =Print: •*_ j #DD 808141 .Q� y my commission Expires: �^ r' M Co ISSYON 11707 i 9'•6 Bo �� EXPIF S OCT 16,2012 - '�9 •. i •• o`rs~ eo�ltiroughidS�a►rte �r rt�r+��rsr�r tt,�,rr�r�i�r ,tat tr,Te s+ r***Ir*i lot mall ,air t*,at�r ,�t rar�e+t�r,ra�anwa�r+tat kir k+ti n*�r�r�r�ia�r�r�e�r,��i s �r,��e,�iw* APPROVED ttG !G Plans Examiner Zoning Engineer Clerk checked (Revised 07/10/07XRevised 06/1012009)