EL-15-808 Invoice
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795-2204 Fax: (305)756-8972
For Inspections please call: (305)762-4949
Return o
E
Shores Village Permit Number: EL-4-15-808
N.E. 2nd Avenue Invoice Date: April 09, 2015
Shores, FL 33138-0000 Invoice Number: EL-4-15-55123
Bond Number:
Bill To Comments:
ENRIQUE CARDENAS LIZETH ZEPEDA CAM
9509 N MIAMI Avenue
MIAMI SHORES, FL 33150-
2601) hl AAIAARI AveRue
MIAMI SHORES, FL 33150-
Per iVnip: fec rWa e0tia Jr, 'Dark Classification ;Alarm
Date Fee Name Fee Type Fee Amount
04/09/2015 Scanning Fee Calculated $3.00
04/09/2015 DBPR Fee Calculated $0.00
04/09/2015 DCA Fee Calculated $0.00
04/09/2015 Permit Fee -Additions/Alterations Percentage $100.00
Total Fees Due: $103.00
Payments
Date Pay Type Check Number Amount Paid Change
04/09/2015 Check 3973 $103.00 $0.00
Total Paid: =$103.0=0 ]
Total Due: $0.00
Thursday,April 9, 2015
Miami Shores Village
Building Department APR 0 9 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
FBC 20 /Q
BUILDING Permit No. EL-8-14-1779
PERMIT APPLICATION Master Permit No.'Lf
Permit Type: BUILDING ROOFING
JOB ADDRESS: 9509 N Miami Ave
City: Miami Shores County: Miami Dade Zip: 33150
i
Folio/Parcel#: 11-3206-013-0670
Is the Building Historically Designated: Yes NO X Flood Zone:
OWNER: Name(Fee Simple Titleholder):Campos Lizeth Zepeda Phone#:786-238-7442
Address:9509 N Miami Ave
City: Miami Shores State: FL Zip: 33150
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: SafeStreets USA Phone#: 919-861-8521
Address: 5660 W Cypress St Suite G
City: Tampa State: FL Zip: 33607
Qualifier Name: William Alan Peacock Phone#: 919-861-8521
State Certification or Registration#: EG13000404 Certificate of Competency#:
Contact Phone#: 919-861-8521 Email Address: Jadams@safestreets.com
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $9900 Square/Linear Footage of Work:
Type of Work: ❑Addition I.0Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: **RENEWAL"-Wireless Burglar Alarm- 1 Cell, 1 Panel, 1 Button Fob, 13 Door/Window, 1 Motion,
1 Shock
Color thru tile:
** **************** ******* ********Fees*************
Submittal Fee$ Permit Fee$ 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,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 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 g Silm ature l/"�""' �y^• R,�
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 7th The foregoing instrument was acknowledged before me this 7th
day of April 2015 by Campos Lizeth Zepedaday of April 2015,by William Alan Peacock
who is personally known to me or who has produced DL who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY P IC: .1ARRUU M.ADAMS NOTARY P BLIC: JARRUD M.ADAMS
NOTARY PUBLIC NOTARY PUBLIC
STATE OF FLORIDA ' STATE-OF FLORIDA
Sign: Y Comm#EE180338 Sign: s
rro Adams 'a^" ` `� ;,os 3/18/2016
Print: Print: a Adams `M^� "-err;rPs 3/18/2016
My Commission Expires: 3/18/2016 My Commission Expires: 3/18/2016
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)