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EL-13-219Miami 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 Permit Type: Electrical JOB ADDRESS: 64 • 1 09111 ST FEB 0 6 Zp13 � L FBC 201st Permit No. q- L-.1 5 '2:19 Master Permit No. 12 -16°e) City: Miami Shores County: Folio/Parcel#: 1 J - 24 3(o — O0 r%— 0 f •Ct Miami Dade Zip: Is the Bolding Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 1d r-c • Z E Address: St+ ht, (,l). 0 qv City: tA e SVIDP-70- State: R.-- Tenant/Lessee Name: Phone#: Email: ONTRACTOR: any Name: 2-XC EI - 0 Con p — s: ,g514-10 N W t &,s -�a Phone#: rl S 4 -ZS r)--. 6.0 I H.110.14:1 State: Qualifier Name: 6+ e,vD \ A E_OSTA, State Certification or Registration #: ee-1 ®� 11/6 Contact Phone#: A MRDt4 o o kccs-rik Email Address: Zip: Phone#: 0 i;4- 34-99-668 Certificate of Competency #: AC.oarfropi 0 09MA i 1 • co l'1 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ c', /00.0 e Square/Linear Footage of Work: Type of Work: OAddress OAlteration (Blew ORepair/Replace ODemolition Description of Work: /V u) Awe-6 2ECqrrC'/EES 1 Arnif15 a a**** * * * * * * * * * * ******+x** **a *s ** *** * * ** Fees************* e *se ***** **** ******** * ****** *** Submittal Fee $ 5 0 k9 Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ . lhonding 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 t j ' bsence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Owner or Agent The foregoing instrument was acknowledged before me this Z_ day of su11 , 20 12, by P cX W J . IM£I icy whoj&pexsonally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: / ,gye Z. My Commission Expires: p��a�r Pt,,, OLGA L. CRUZ ,. t�` s , rem,= �©` % -.,, Notary Public - State of Florida , •2 My Comm. Expires Sep 23, 2013 r, of Commission # DD 894805 " *IV Bonded Through National Notary Assn. Contractor The foregoing ins � ent was acknowledged before me this day of se r , 20(2— by Ate 9 t) 460s0 who is personally known to me or who has produced as identification and who did take an oath. • NOTARY PUBLIC: Sign: Print: �•1PRV nod �: My Commission Expires: 043/1" Notary Public - State of Fiorft12 My Comm. Expires Sep 23, 2013 Commission Dn 894805 Bonded Through National Notary Assn. ***************************************************************************** *** *** * * * * * * * * * *** * * * * * * * * * * * ** APPROVED BY Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk