RC-10-824 (2) Miami Shores Villageo 303E 3
Building epartment MAY I 12010
f0050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972 � " """°°°°
BUILDING Permit No.^ 01✓
PERMIT APPLICATION Master Permit No.w-,� 0 o`l4
FBC 2004
Permit Type: Electrical ��
Owner's Name(Fee Simple Titleholder) -FAA Z�&/ L-\ Phone#
Owner's Address U S T—
City tbAI-A to -�'C_— Zip ���
Tenant/Lessee Name Phone#
E-MAIL:
Job Address(where the work is being done) 7 A1Y
City Miami Shores Village County Miami-Dade Zip
FOLIO/PARCEL# i( AZO[D D i g I Z q d
Is Building historically Designated YES NO.
Contractor's Company Name
Contractor's Address CHIT
City tate Zip5-573101
Qualifier Name CL-r- Phone#
State Certificate or Registration No. 9 - Certificate of Competency No.
E-MAIL:
Architect/Engineer's Name(if applicable) Phone#
Value of Work For this Permit$ Square/Linear Footage Of Work: .�
Type of Work: Addition ❑Alteration /FlNew ZIr Repair/Replace ❑Demolition
Describe Work: "YLVy ��- -17 Z,r/ ' °
Submittal Fee$ Permit Fee$ 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-�
s �
Bonding Company's Name(if a:)plicable)
Bending Con:pary•s AdOress
City State
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a pennit 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 oceans 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.
9 tjn,�!=t
Signature �.l Signature P
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20_,by �'tc 7;,Q Y1,gA1t,'ff , day of ,20_,by !;2r�&0E,
,
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 o as identification and who did€eke an oath
NOTARY PUBLIC: NOTARY PUBLIC: r Si�18Ar�SH
lbNCCi SSt t OtJ WC #DO7 9278
E ffftAnO24,2tit2• EXPIRMJMe24.2M
' TMuNa1N 4=WTMuk*#*fdt
Sign Sign
` .
Print: �i ICY Print:
My Commission Expires: My Commission Expires:
APPLICATION APPROVED BY: /9/yGv Plans Examiner
Engineer
Zoning
(Revised 02/08/06)