EL-11-464October 19, 2011
Security
Services
Miami Shores Village
Building Department
10050 N.E. 2'd Avenue
Miami Shores, Fl 33138
Re: Burglar Alarm # EL- 3- 11-464
423 NE 92 Street
C# 84291962
To Whom It May Concern:
Please note that an installation was never performed and we are requesting a cancellation of the reference
permit. If you have any questions please contact Maria D. Perez at 954- 266 -5275. She will provide any
information needed to close the referenced permit.
Thank you,
Ge geM
EF0001121
ADT Security Services
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
BUILDING'
PERMIT APPLICATION
FBC 20
Permit Type: ELECTRICAL �� �
Owner's Name (Fee Simple Titleholder) , / I Aid 4 ,1t ? Phone # 4" / 3 r7 ii
Owner's Address 4/V3 /(,/40. /140,,b jt
City al/MP i / /1 tate
Tenant/Lessee Name Phone # 405 314' Fe5 414
Email
#4.fr
$6?
Permit No. 1 1 _ 9.0
Master Permit No.
Zip /39'
Job Address (where the work is being done) 4l3 I) •
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL # 1/ 06 ctizieel, 21/0
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address
City [No)
Qualifier Name
State Certificate or Regis
Zip
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ n q ' -- Square / Linear Footage Of Work:
Type of Work: ❑/iddition 4-Alteration :New ❑ Repair/Replace ❑ Demolition
Describ Wort:
I
Morm---)
******** * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * ** * * * * * * **
Submittal Fee $
Notary $
Scanning $ Radon $
Double Fee $
Structural Review. $ Total Fee Now Due $ 5r,
Permit Fee $ / d0 :' O CCF $ CO /CC $
Training/Education Fee $ Technology Fee $
DPBR $ Bond $
Violation date:
See Reverse side -
Bonding Company's Name (if applicable)
Bonding Company's Address e
City State Zip
Mortgage Lender's Name ►. applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a pe 't to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a perm • d 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 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 whic rs seven (7) d after the building permit is issued. In the absence of such posted notice, the
inspection will not be appro ed and . e -insp ion fee w l be charged.
Signature �� f
04 WO we
The foregoing instrument was acknowledged before me this The foregoing instrument was ac ed before e this/U
29/.x, bya
who is personally known to me or who has produced ( who is personally known to me or who has produced
identification and who did take an oath.
Contractor
NOT
Sign:
Print:
My Commission Ex
APPROVED BY
ComrAission #DD98
,,, Expires: MAY 03, 2014
BONDED THEU ATLANTIC I,3NIDING CO.,INC
'�. as i •. nt' • cation and who did take an oath.
NOT/
Si
Prin
My Commission Expires:
NOTARY PITBLIC-STATE OF FLORIDA
Monica Agudelo -F1
r
.1 it
orez
TLANTIC BONDING CO., INC
Zoning
*********** * * * * * * * * * * * * * * * ** * * * * * * * * * * * * **
BONDED THRUAAIreS MAY 03, 2014
/4J�1� Plans Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Clerk checked