Loading...
EL-11-1677Miami Shores Village Building Department 10050 N.E.2ind 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: Name (Fee Simple Titleholder): Permit No.t\ LI 1(T 1 Master Permit No. CkLZA 6." c. kca, v Pone#: Address: Gres d Can Got+►r -SQ City: Ak iaw' 1 cS110 LS State: Ffor +dc\ Zip: .33 t st Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: City: Folio/Parcel #: Miami Shores County: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: � 2P City: Lei Qualifier Name: Phone#:�/� '—'57/1 State Certificatio r Regsion' d2// Certificate of Competency #: n Y' Contact Phone# � °" Sf/ % Email Address: G lJ 6% /a. '. Miami Dade Zip: NO Flood Zone: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ /61, ` e Square/Lmear Footage of Work: Type of Work: DAddress OAlteration ew URepair/Replace ODemolitioonn' Description of Work: ( ,') , &aii_ / r (i)6i.f l ). ddie ****** i**** �x�x�a ****** *4!�x*** *�xx��x+xx� *x�x:� *** Fees**** * * *4*a: *u ** ** *4 4 4 i:** * * * **** * * * ** Submittal Fee $ Permit Fee $ / i, ,C2 ' ea 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, BEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing informatign-is- accurate and' that all work will be done in compliance with all applicable laws regulating construction and zoni "WARNING TO OWNER: Y(TJR 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 cJmjg d. Owner or Agent The foregoing instrument was acknowledged before me this ' The foregoi ledged before me thi/ cto day of ,tbC,. iC20 ., by wa... G c I , day of who is personally known to me or who has produce who i s dr i i.... C' leevi92 As identification and Oho ddid tape an oath. , NOTARY PUBLIC: Sign: Print: My Commission Expires: onally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commi AITATZ *** *s= * * *>x** ** *may * * * ** * * ** **** th i3 -2 Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) ...vP ALBA H. AGL'LA Notary Public - St ;,e of Florida ,9 ,r My Comm. Expires. Jul 26, 2015 '' %°F`,,,, Commiss n '' EE 1 OR Mit- Zoning Clerk