SEN-06-2356 i
SEWN 23%
Z
J
0
i
Miami Shores Village - -�- , .�a
Building Department AF � � 20,E
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 �� I
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-0949
FBC 2014 _
BUILDING Master Permit No�l-+ MY6-23
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC 1 ROOFING REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OFCANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: ( ,l Flood Zone: BFE: FFFCE:
OWNER:Name(Fee Simple Titleholder):Elm(k `� vS Phone#:-�ffo—G1 J`3—Z JY33
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email: /�r
CONTRACTOR:Company Name: �/�'N S .� Phone#: l%�o 5l I
Address: � � 2•a N
-TCCity: State: Zip: 3 3l�O
Qualifier Name: �t4 —""`-' Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: —��, y� City: State: Zip:
Value of Work for this Permit:$ [tM.� Square/Linear Footage of Work: �2
Type of Work: ❑ Addition ❑ Alteration n' New ❑ Reepaiirr/R lace ❑ Demolition
Description of Work: �
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS,TANKS,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 periD�tFr an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencem construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified co corded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after th tlding permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
LSignature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of A ,2,t`1 20 �� by day of .20 by
�r I
I%0 ONEWS,who is personally known to who is personally known to
me or who has produced h--lo� .1..� me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY LIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print:
Seal: �`OAYPN, Notary Public State of-lords ' Seal:
? Sindia Alvarez
`� _ _ �`� My Commission Fr 5677,-'t
FOFcrop -xpiirre509103/2018
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
April 3, 2017
From: Elvia Romelus
201 NW 91"Street, Miami Shores, FL 33147
Request for permit Cancellation
To: Building Official
Miami Shores Village, Building Department
10050 NE 2nd Ave, Miami Shores, FL 33138
Dear Building Official:
Please cancel the Screen Enclosures Permit No: �� 2 � applied on September
15, 2006 and issued on November 20, 2006 min regard of my property located at: 201 NW 91St
Street, Miami Shores, FL 33147 Permit is been issued to me but no work has been performed at
the property. I'm available to collaborate in any inspection concerning this permit cancellation
request. Should you need any further info,please let me know. Thank you
Best regards
Elvia Romelus, Owner
�
Phone: 7 C 5--�CB