EL-18-2201�9r!ORes y��
Miami Shores Village
4�
10050 N.E. 2nd Avenue N
Miami Shores, FL 33138-0000
Phone: (305)795-2204
F�ORiDp'
Permit No. EL-8-18-2201
Permit Type: Electrical - Residential
Perm'It
Work Classification: Temp for Test
Permit Status: APPROVED
Issue Date: 8/21/20'118 1 Expiration: 02/17/2019
Project Address Parcel Number Applicant
9400 N BAYSHORE Drive 1132050100110
AMINE DOUKKALI MARIELA B F
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
AMINE DOUKKALI MARIELA B ROVITO 801 N VENETIAN Drive (305)992-6776
--- MIAMI BEACH FL 33139-
801 N VENETIAN Drive
MIAMI BEACH FL 33139-
Contractors) Phone Cell Phone
MV ELECTRICAL SERVICES (305)216-0677
Type of Work: TEMPORARY FOR TEST
Additional Info: TEMPORARY FOR TEST
Classification: Residential
Scanning: 1
Fees Due
Amount
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee -Add itions/Alterations
$100.00
Scanning Fee
$3.00
Technology Fee
$1.60
Total:
$110.20
Valuation: $ 2,000.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-8-18-68594
08/21/2018 Credit Card $ 60.20 $ 50.00
08/20/2018 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Review Electrical
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and 4ing.,Fvtjifflitnor a the above -named contractor to do the work stated.
August 21, 2018
Autfiorii'd Sigritdure: OWPO / Applicant / Contractor / Agent uate
Building Department Copy
August 21, 2018 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APP CATION
BUILDING ELECTRIC ❑ ROOFING
AU 2 0 'T9
FBC1120 ff
Master Permit No.?C06 - b
Sub Permit No. 'E u\oo "n-B i
❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Folio/Parcel#: 0 - 3 �'O s - D% 0 - C') / / p Is the Building Historically Designated: Yes
Occupancy Type:. Load: Construction Type: C ja _Flood Zone: BFE: _
OWNER: Name (Fee Simple
Address: \ `/
City: A r'''U
Tenant/Lessee Name:
Email
NO A
FFE:
holder): Phone#: 3� �"y -pa (ID
^ State: �l� Zip: 3 3 ( 5
Phone#:
CONTRACTOR: Company Name: � � ' , 7 � � C Phone#:
Address: `O� � \ " � e
City:State: Zip:
Qualifier Name: �C� c� pp Phone#:
State Certification or Registration #: C� ��O�s OO Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address: City: State
' Value of Work for this Permit: $ Zd 00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Zip:
❑ Demolition
Specify color of color thru tile:
r
Submittal Fee $ Sd �a Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $2 ` �` DBPR $ 2 ' Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ �0' Z0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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.
Signature �. Signature
OWNER or AGENT CONTRACTOR
The foregoing instru ent was acknowledged before me this
day of . 20, by
ho is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal: tfaA CLARISSA A, RODRIGUEZ
MY COMMISSION # GG 041376
EXPIRES: December 30, 2020
:•. �?-.-i ed Thru NotaryPubic Underwriters
The foregoing instrument was acknowledged before me this
day of
20 by
Y who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: �-
Print:
%''•
CLARISSA RODRIGUEZ
Seal: ,�'
COMMISSION # GG 041376
30, 2020
EXPIRES: December
Bonded Thru Notary Public Undernrtiters
as
************************************************************************************************************
APPROVED BY�i� 2m/t4S�/� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)