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DEMO-10-1436Miami 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 Type: ELECTRICAL Owner's Name (Fee Simple Titleholder s �, �( (� `�(nv tME�nlr� phone# 3o5 -1) 9- gC) (10 Owner's Address 3 V 5 0 .b l PA Rood CtC 4'b ®f t Ci 1 State Zip ' 33 i kt co Tenant/Lessee Name \IQ.. C.CA.,n Email 1 RcCY1t425 a- C .C1n C i rO u 1- t C O rvl IPMERVED AUG 1 0 2010 �J BY: ......a .,..... Permit No. Val0 10 N3 Master �, r Permit No.� O 1 n' Job Address (where the work is being done) Phone # ` )IOS _ 11 – So - o City Miami Shores Village County Miami -Dade ` FOLIO /PARCEL# l - 3a( --01 t- 005 I Is Building Historically Designated YES NO Zip Flood Zone Contractor's Company Name AW p_ov tOA,pt s lhL Phone # 5 - 0 Contractor's Address _100017 C. (, 4i- City PC114–A►T1O ate _ ip 332324 Qualifier Name Phone # ► , 1 s - '� (786) Zq ©— 07&4, State Certificate or Registration No. . COC12.00 2 Contact Phone C7e 6) 2_ci0 - 07 f 34- E -mail lam 8r vtLc.D t am, .corvx, Certificate of Competency No. Architect /Engineer's Name (if applicable)TSOS.Q. RQyr1O5 Phone # qSy —rji ) —g5` 0 Value of Work For this Permit $ 14 000. D0 Square / Linear Footage Of Work: i, / 3 Z � 1 Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace cqj Demolition Describe Work ► R', - tCer�� � 1ctj ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ees * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ /0.0 &o CCF $ ' CO /CC $ Notary $ Scanning $ Radon $ Double Fee $ Violation date: ,,� Structural Review. $ Total Fee Now Due $ \ V (� • (.d Training/Education Fee $ DPBR $ Technology Fee $ Bond $ See Reverse side –� 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 wit an estimated value exceeding $2500, the applicant must promise in good faith th t a c y of the notice of commencement and ion lien law brochure will be delivered to the person whose property is su for the first inspecti inspection will not b e bj: to � #chment. Also, a certified copy of th o i ccurs seven (7) days after the b '•a? Signature G otice of commencement must be posted at the job site mit is issued. In the absence of such posted notice, the i Signature 0 Age Contractor The foregoing instrument was acknow ed before me this "a% The forego' g instrument was acknowledged before me this /0 day of Aw , 20 \t , byI ®YN(.S CL o r e r i Z.Q , day of k , 20 /D by Seee (o Let . e i'.Ii who is personally known to me , or who has produced who is personally known to me or who has produced 7 L As identification and who did take an oath. 424-710 'y l -1 g'("gidentification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: 1� Ednl My Commission Expires: ALENE EDMON0S My Comm. Expires Aug 29, 2014 t-'44 " •' Commission # EE 8916 "R" Bonded Through National NOB" Asai. /c.) APPROVED BY /o,o ' Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Sign: Print: My Commission Expires: RAY BACCHUS 1►�+ Ge . `^ Notary Public State or Fla • 5 My Commission Expires Jun 26, ; — intents on # 00 800999 ' ", ,, ,,, Bontled Through National Notary p - -�-Tar Zoning Clerk checked