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EL-07-241511J1 tt+.'&L I&o a't co,�u Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical Owner's Name (Fee Simple Titleholder) NOV 3 0 no � B Y: __(,!- Permit No. M-415 Master Permit Noth Q 01-255T rig (kkC,_ 0 Phone #S0c, 112 Cog 10 Owner's Address 'j /�/p� (J4. Sleo Z. City IAN `` IhnA i Q (tQ State PC_„ Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City Miami Shores Village Zip Phone # FOLIO / PARCEL # County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name Contractor's ddress City Zip Qualifier Name to /'[O % zip ?a / q t? d Phone # g 6 34 r [ 1 State Certificate or Registration No. /3 0 /24 f� E -MAIL: Architect/Engineer's Name (if applicable) Value of Work For this Permit Type of Work: ['Addition Describe Work: Certificate of Competency No. ©_E 0 ©0 82 Z ❑Alteration Phone # Square / Linear Footage Of Work: ❑New ❑ Repair /Replace ❑ Demolition ***************************************Fees******************* ** **,r***** ***** Submittal Fee $ Permit Fee $ AP®/ ®4:19 Notary $ �-- Scanning $' Bond $ Training /Education Fee $ 040 Radon $ CCF $ ©` c) CO /CC Technology Fee $,,,J DPBR $ Zoning $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ tatr'30 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: 1 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 reinspetion,fee will be charged. Signature Owner or Agent ' g � Contractor The foregoing instrument was acknowledged befor M a , he fore Ding inst ment was ackno l we befor me this 2 Y if l day of , 20 by 1 day of /��4I�I�► D�1' , 20 �, by 4/ I O rtpJ who is personally known to me or who has produced who is personally known to me or who has produced "(// hirer I / p/J 4 c As identification and who did take an oath. R5'2042.36434' ent cation and who did take an oath. NOTARY PUBLIC: NOTARY PUB IC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: x4:x x xxxxicxxxxxxxxiexxxxxxxxxxxxxxx xx xxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxB : xxxxxxxxxxxxxxx APPLICATION APPROVED B (Revised 02/08/06) Plans Examiner Engineer Zoning