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EL-08-717 (2)1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 1200 NE 91 Terrace Miami Shores Village, FL 33138- Owner Information Parcel Number Expiration: 10/25/2008 Applicant 1132050010490 Block: Lot: CULLEN & CRISTAL LANE Address Phone Cell CULLEN & CRISTAL LANE 1200 NE 91 Terrace MIAMI SHORES FL 33138- (305)498 -9822 Contractor(s) ADT SECURITY SERVICES, INC Phone CeII Phone (786)331 -3967 Valuation: Total Sq Feet: Type of Work: ELECTRICAL Additional Info: ALARM Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $100.00 $3.00 $2.50 $106.30 Total I Amt Paid I Amt Due $ 106.30 $ 106.30 Payment Type: Check / Number: 9920 APR 2 8 PAID $ 1,000.00 0 Available Inspections : Inspection Type: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy April 28, 2008 Date Monday, April 28, 2008 1 Miami Shores Villag Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 BY: Permit No. O?1 l 1 Master Permit No. Permit Type: Electrical Owner's Name (Fee Simple Titleholder) C(JLLwt `" Phone # 1...5) ZJQ ft/3 Owner's Address /260 10A '9C 71C/K ku City C J% 2J- ?State Zip Tenant/Lessee Name E- MAIL: Job Address (where the work is being done) A9-0 0 '97' 19/ City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # lI7 2 OS )O / 0 qqD Phone # Is Building Historically Designated YES Contractor's Company Name NO cf Contractor's Address -CS1O / 674e4, 91 �4 City G ,GC�4 State Zip 53® 4' Qualifier Name 6e ©� ,fre/.e2 "7,1/,7.0//, ° Phone # Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Type of Work: ❑ dition ❑Alteration Describe Work: ( Square / Linear Footage Of Work: ew ❑ Repair /Replace ❑ Demolition ******* xxxxxx*** xxxxxxxxx** xxxxxxxx* xxwFees********* xx xxxxxx * * *xxxxxx *xx *xxXxxxxxx * * * ** Submittal Fee $ Permit Fee $ /O a �� CCF $ �v CO /CC Notary $ Scanning $ OO Training/Education Fee $ 0 °2J Radon $ Technology Fee $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ tom; c)0 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: 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 promise in good faith that a copy 9f' whose properly is subject to atta for the first inspection hich inspection will not be • .. prov to the issuance of a building permit with an estimated value exceeding $2500, the applicant must the notice of commencement and construction lien law brochure will be delivered to the person lso, a certified copy of the recorded notice of commencement must be posted at the job site (7) days after the building permit is issued. In the absence of such poste the ection fee will be charged. Signature Signature K 0 r ner or Agent The foregoing instrument was acknowledged before me this day of ,20,by Contractor The forego' g ins ° ment was acknowledged before me this day of ,20_,by who is personally known to me or who has produced who is personally known to me or who has produced. NOTARY Sign: Print As identification and who did take an oath. BLIC: PI NUNEZ MY COMMISSION # DD 460279 EXPIRES: September 11, 2009 Public Underwriters My Commission Expires: w w w ww w**** ****xx**wwww xxx w w*w wwwww ww w ww x,c** APPLICATION APPROVED BY: (Revised 02/08/06) as identification and who did take an oath. NOTA PUBLIC: R� PUe�s, HUBERTO NUNEZ ,, 4 MY COMMISSION 4 DD 460279 Yn Sign: J _"' EXPIRES: September 11, 2009 p My Commission Expires: xxx w w* w w x wx w Xw wwwY. wY. ww w wwww wwwww w c-f Plans Examiner Engineer Zoning