EL-13-2105 Miami Shores Village cry
F F 1.. 7 2013
Building Department
10050 N.E.2nd Avenue Miami Shores,Florida 1
BY:
S 33 38
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
BUILDING Permit No.
PERMIT APPLICATION Master Permit No F/ 13
FBC 20
Permit Type: Electrical
OWNER:Name(Fee Simple Titleholder):J0 '4 ` Phone#: .1()�^q 9Q 0 7,5 `i
Address: 9 CP 5 , E7 9(.0 E -
City: tom}M t 51- o a- - State: EL Zip: E313�
TenantfLessee Name: Phone#:
Email:
JOB ADDRESS: T1 Cp
City: Miami Shores County: Mtaamti'I Zip: 3 S f:3S
Folio/Parcel#: I 'Do(O
Is the Building Historically Designated: Yes N0— X Flood Zone:
CONTRACTOR:Company Name: Phone#: `
Address: �o/�O• �//L� /�
City: tate: `7Z
Qualifier Name: G�,� �_� c Phone#(��61 " �Z<5
State Certification or Registration#: —Certificate of Competency#:
Contact Phone# � ail Address: �[� s
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ � 7. (520 Square/Linear Footage of Work:
Type of Work: Ll Address ❑Alteration New ORepair/Replace ❑Demolition
Description of Work: -rn&Aia ►Icy ;err, l;g al CL�Uv'M f C le g S, C A n1U/- S
***************************************Fees********************************************
Submittal Fee$_ LA-.1 �Permit Fee$ /3�® y�'D CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
Irnding Company's Name(if applicable)
r
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature LSignature L✓''
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The P& ment was acknowledged before me this
day of ,20 13,by day of ,20 ,by
who' personall own to me or , ro ucewNA$vho is rsonally known to me or who has produced T
m
As identifica' 9 �b�ilAlHeDS1A�.tt EES79200 as identification and who did take an
NOTARY P LI - EXPIRES February 26,2017 M0 (n z D
q# CM OTARY PUBLIC: X 9 D o =
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Sign: -y Sign: m -n C m
Print: . 1- Print: ^' W
My Commission Expires: 2 G,t�arL� 5.(p(a p�h My Commission Expires:
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APPROVED BY %' S�� Plans Examiner zoning
Structural Review Clerk
(Revised(Y7/10/o7)(Revised 06/10/2009)(Revised 3/15!)9)
QV 2 2015
Maria J Gonzalez
765 NE 96 street
Miami Shores , Florida 33138
PH: 305-490-0754
RE: Process NO. EL-9-13-2105
Address: 765 NE 96 st
Dear Miami Shores Village Building Department,
This is to inform you that the permit that was obtained by ADT for a
outdoor security camera was never installed.
The permit needs to be cancelled since the work was never done.
Thank You and please feel free to call me to verify that the outdoor
cameras were never installed by ADT or any other company.
Maria Gonzalez
i��