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EL-11-1275OVA Yy4a/ BUILDING PERMIT APPLICATION FBC 20 Miami 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 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Address: 3a; 1%4 G'6LSt Ma ltGtt) 'Pam Permit No. 27 —71-42 2 aS Master Permit No. Phone#: ,O5 - `i 5 r - ,4y ) City: 1w ia-mj Shove$ State: r-, Zip: 33(3? Tenant/Lessee Name: Phone#: JOB ADDRESS: 363 N3 Cl (0-t-31 City: Miami Shores Folio/Parcel #: 1 1 32-'0(0 01; �' O Is the Building Historically Designated: Yes County: Miami Dade CONTRACTOR: Company Name: ADT Address: p�L0725 /14a ri-S WG� City: rG l fairlo. -c- State: Qualifier Name: 6- e- 9,L - £4.0 -,t' t re.l l t State Certification or Registration #: E) POD D / Z/ Zip: 3;13f Se-r✓ IGCS �lC 7cLQ Contact Phone#: 991 -d -toto -Sp S% Email Address: Flood Zone: Phone#: 4s "A610 -50.57 Zip: 3 30A-5 Phone#: 15-41- A-06 -5057 Certificate of Competency #: My GP.QO(. co-t- caw) DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ /OO- -"---. Square/Linear Footage of Work: Type of Work: °Address ($Alteration °New ORepair/Replace °Demolition Description of Work: 1 I) Oa-112M 0Y) 0C b et, 5(e o4a-i» *********** * * * * * * ** * * * * * * * ** * * * * * * * * * * *I., ************* * * * * * ** * * * * * * * * * * * * * * * * * * * ** * ** e7 Submittal Fee $___� Permit Fee $ ''l' ` C" 6' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ C.d �� L) 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 FT.RCTRICAL 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 P-" YIN(' ICE 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 Owner or Agent The foregsting ' trument was acknowledged before me this 1 day of , 20 IL, by L1A E S t who is personally known to me or who has produced t.0 As ide NOTAR Ati My Commission ) pires: Sign: Print: * * * * * * * * * * * * * * * * * * * * ** APPROVED BY /'ntractor The foregoing instrument was acknowledged before me this /17/ day of 70 /5/ ,20_,by6eerYc�. o ti,12./ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission ******************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** iZ- 4_ arleir Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) i * t;„ oQ * Notary Public State of Florida Aracelis Trinidad My Commission D0945822 Expires 12/10/2013 * Zoning Clerk To: Page 3 of 3 2011 -08-22 15:31:43 EDT Hunton and WIIliams From: Espersen, Deborah =i izr AUG 2 3 2011 VIA FAX: 305 -756 -8972 August 20, 2011 Miami Shores Village RE: Permit EL11 -1275 (ADT) 383 NE 96 Street Miami Shores, Fl. 33138 To whom it may concern: This letter is to confirm that ADT will not be installing any new devices in our home and therefore we will not be moving forward with obtaining a permit. Please withdraw any request made by ADT for a permit to do work in our home. Please don't hesitate to contact me at 305 - 536 -2704 with any additional questions. any thanks, 9)(PiC A / diAA ace M. Mora 383 NE 96 Street Miami Shores, Fl. 33138