ALARMSS 9O -
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Data, . Hoz Job Address 121$ ►JF. 101 ST . Tax Folio �� - 32- OS 0Z( 002-0
Legal Description (Ar S 13(14_ 12 7 A /Pictgic..42._ f 4. L 0 Historically Designated: Yes No
Owner/Lessee / Tenant a,0171 °'d a itNe Master Permit # (i Z • 2
Owner's Address 1 a 1 8 NE /01 S 1 Phone
Contracting Co. P ry t_ C / : on 0 n -e Address 3 01 SG rv‘ e
Qualifier ss# Phone 95 L/ ?700-3061C 221
State # E F00011) l 0 Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 20 C)
'"'r\
) r ot, ! 7 dew''( e1'
Square Ft. Estimated Cost (value) . 7 9S; OD
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
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
constructipnand zoning. Furth re, I authorize the above -named contractor to do the work stated.
Signature of 6wner and/op'Cghdo Presid
Notary
My Co
FEES: PERMIT
APPROVED:
Zoning
Mechanical
r .•vp,•'r, ,,,,,,.. K. Tu
;�, er and/or' Co '•s`�
V
• • ,r Expires: ,, Thru
F; ..,; bailing Co., Inc.
RADON
Plumbing
di /0 L.
Date
Date
C.C.F.
Signature of Contractor or Owner- Builder
�,,,: t• era K. Tuc r s
•��l �ne•n:<< N� 1•,•,' •r - Cum
4°Xk
o Atlantic Bonding Co., inc
Building Electrical
er
BOND /�
TOTAL DUE 6 (J' e /,o
Structural Engineer
7/o2
Date
, VILLAGE OF M'sAMI SHORES, ALARM PERMIT APPLICATION PERMIT EXPIRES SEPTEMBER 30, 19
1) Nar ' of Business ❑
or eNident
Name
11619 i ki carJnl A.rnl "I
2) AdJred3
3) Zip 3 3138 • Phone 36F 7E 7 If -!24
LOCATION OF PROPERTY FOR POLICE TO RESPOND
4) Mailing Address SA-Mt
(if not same as above)
5) City State Zip Code
12(8
(o( Sr
r
L (� 0 Soo .-1 "-N.1
Name Phone
OFFICE USE ONLY
PERMIT NO
You must notify your Alarm company of
the VALID permit number for POLICE
RESPONSE
DATE
Clerk
CK. # AMOUNT $
PERMIT(S) AMOUNT $
INVOICE(S) AMOUNT $
Computer Entry
6) Business Applicants Only: Name: Phone:
Name, Address and Phone of
wnom you rent building space from Address:
mergency Listing List individuals with keys to respond in case of an emergency to shut off alarm
7) Name (41(1^I Cr' < Phone 9St-( (o '-fo I 3 -
Phone
3or (,3o 134Z—
YOU MUST NOTIFY YOUR ALARM COMPANY OF THE VALID PERMIT NUMBER FOR POLICE RESPONSE
-1
8) Alarm Company Servicing Alarm System —a-` r o Phone 365' S1 U ,3000
(■ 1,
9) Alarm Company Monitoring Alarm System Phone
ft `
10) Name of Person Completing Application Phone
PAY
TO THE
ORDER OF
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 8/13/2002
Applicant: BRENDA
Owner: HOWELL
JOB ADDRESS: 1218 NE 101
Contractor PROTECTION ONE
Local Phone: 954- 970 -0300
Parcel # 1132050210020
Bank ofAmerica.
Fees:
FEE2002 -4510
FEE2002 -4511
Description
Building Permit Application Fee
CCF
Total Fees:
Amount
$60.00
$0.60
$60.60
Total Fees: $60.60
Total Receipts: $0.00
O Work: BURGLAR ALRM 1 PANEL 7 DEVICES
Permit Status:
4 ' 1 / a rnt
/G a
Customer Connection
Approved Permit Expiration:
- " - _ if - — - - — - - - ' rr a ri 1y nha rrJ Ju u moot Sre _nark fo ,r iu 11 s.fl -
ssii�.nmmsrca - 'n�nac�r� 5 _ _
PROTECTION ONE - FLORIDA PERMIT
2301 W. SAMPLE RD. BLDG. 3 STE 1B qst/ 947 0 3o t7
POMPANO BEACH, FL 33073
SAO ref
Electrical Permit
Permit Number: EL2002 -261
Legal Description: MIAMI SHORES SEC 8 AMD PB 42-40 N100FT LOT 5
2/9/2003
DATE
FOR
ll'OO L 2 4Loa I :LLL0000 21: 375 L47 7206ii'
HOWELL
BRENDA
ST
Contractor's Address: 2301 W SAM PLACE ROAD
Construction Value: $795.00
J// 7/Z
I $ 40,60
1241
32 -1 /1110 TX
0
DOLLARS 8
- a .rcot..._ n ,mr.,.stast. .._.,. 4#,utams:u.. aotat-a., lomat, ,. -r.J u u icana � ,s. � ,s -• u,1 ,,« �
Page 1 of 1
. Re- inspection
BLK 184 A LOT SIZE
application herefor in strict compliance with all
specifications that may have been submitted to
ances or if the plans are changed without
responsibility for a thorough knowledge of the
and that he assumes responsibility for work done
Jlations pertaining thereto and in strict conformity
Mme responisibility for all work done by either
Gentlemen:
Miami Shores Village
Building and Zoning Department
Miami Shores, Fl 33138
RE: Property located at (address and legal description)
f. /$ n2E cs'
/
•
aes
HOLD HARMLESS
As legal o er of subject property, I request the cancellation of perm
to /N '11..x.• , for the following reason:
P/'S CA�NG 4. f GA1 1 M & D 1/dQ-?7O
►--c,,ON+tJ ' f •
Very truly yours,
Notary Public, State of Florida at Large
(signature)
(print name)
Date 1110
fL ZooZ --Z6 (
tlVade'Q
number issued
b /tie 1 ,4 _
Date of last inspection:
I hereby apply as owner- builder, or authorize (new contractor)
to apply for such permits as necessary to construct or complete the construction on subject property.
I agree to hold Miami Shores Village, its agents and authorized.personnel harmless and relieve them
from any responsibility or liability for any legal action or damage, cost expense (including
attorney's fee) resulting from the cancellation of the existing permit or the issuance of a new permit.
I furthermore assume responsibility for the correction, if required, of work performed under the
permit for which I am requesting cancellation.
Prime contractor (only if
subcontractor holds permit or if
change of qualifier).
STATE OF FLORIDA
COUNTY OF DADE:
The undersigned, being the first duly sworn, deposes and says that he /she is the legal owner of the
above property. ' co 44(/ . 't my
Sworn to and subscribed before me this / X day of _ of /
t r y
OPP
Zoe' c 6 s 32 6.546