ELC-11-957r•
MOODY ELECTRIC, INC.
www.maxlyelectric.com
669 N.W. 90 Street • Miami, FL 33150 -2166
Tel: (305) 758 -2000 Fax: (305) 754 -1333
March 1, 2013
Miami Shores Village Building Dept.
10050 N E 2 Avenue
Miami Shores, FL 33138
RE: Permit #ELC -11 -957 —11300 N E 2nd Avenue
To Whom It May Concern:
Please be advised that no work was performed for this permit. Application was made but
customer changed their mind.
John J. Moody
WO/ /99
Subscribed and sworn before me, this 1
day of l , 13 a Notary Public
in and for ► DE, County,
State of L
Pod-
(signature)
NOTARY PURL
My Commission expires
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
lam[
Master Permit No.`. XL t ®1
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): 124J(tlei-,4 / Tir Phone #:
/ /cr?i-
Address: it/' • 2' . U
City: muari/t ,,tiler tf
State: t�'GD bra' v1�
Zip: 33 /3,0,
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 1 1U-el 1U-e E 2.4.4
City: Miami County: 3 31 54
ty: ty. � -� �, a% Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO ;Flood Zone:
vI�G LG/ 4re, Phone #: J J 7.' • ?marl
CONTRACTOR: Company Name: )4
Address: o 9 it% -W • ye)
City: /,'i7 /,„44,�.
Qualifier Name: ,JO,tl* J ...% •
State: Gtole. AOA Zip: 33 /.570
Phone #: j ' 75 .i • z•ha'a
State Certification or Registration #: e f ' g9 Certificate of Competency #:
Contact Phone #:.�4.1�' Are.. • Email Address:
DESIGNER: Architect/Engineer: Afi/i'
Phone #:
Value of Work for this Permit: $ f%76"6. --" Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration IYINew ❑Repair/Replace Demolition
Description of Work: 5PU0 i/10d 4 Ausr -i-LG- sevaiedo 6. AJ A 'ArldiT
f , is Me* 5 . Cam- mac/ T" [.I - , r3: gil Cam,) 3 -w .:
.�.�r fedS•
Submittal Fee $ Permit Fee $ ,/ eo r06 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 approve, end a reinspection fee will be charged.
Signature
Iffy-
Owner or Agent � Contractor
The foregoing instrument was acknowledged before me this `v he foregoing instrument was acknowledged before me this t341-
day of MAY 20 1 day of �t� 20
, by �F .,µ(,b G JvW�IU�U' ^_, Y P r r _It, by 9 &AZ - L
'
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:
Sign:
Print:
My Commis' • , ..':.lftQ1Sc ;.0 • } „J n,.;..� MY COMMISSION 2014 COii r ..
Od� .r : �aw� r ov F7 Na auaa Ca a ;et 4PO _ MARY PAT BRIGGS
* *: RAYCOMi41&"".m# i7 ;267
o EXPIRE:" 411
T F
************************* * * * *** *** * * * * *** ** *** * * * *** * **** *** ** * * * * ** JO n* fiThAiPts * *.116 1MliPati3 *** ** * * ***
NOTARY PUBLIC:
APPROVED BY
,iiizeiyzo Plans Examiner
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)