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Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
NOV 3 0 2017
FBC 20'"'
BUILDING Master Permit No. '4V i 1'-A' .S 2
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF g CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I 1 Lp 0 1L -%'a q7SSI
City: Miami Shores County: Miami Dade Zip: 3 51 g
Folio/Parcel#: DoZ (y5 — (' 'ct) - DJ� Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1\19---\1 .C.� �A c Phone#: (3,76 —(00�'1 —009 I
Zip: 1�
Address: ' \ (.a 0 L) r 6( 66 ST
City: Pr° --k < \ O' S State:
Tenant/Lessee Name:
Email:
er` r ® g \ I cuuD . c_04A
Phone#:
CONTRACTOR: Company Name: Phone#:
Address:
City: Zip:
Qualifier Name: �\rt Phone#:L "1 " �
State Certification or Registration #: Certificate
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
.47 s
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace n Demolition
Description of Work: c2 n_10 -tiny)
w g or-
-2 2.
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 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 Signature
OW or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
3D" day of NO\i'r 'OC I , 20 \'l , by day of , 20 , by
I o�/IOIf 1) PIG )Q , who is personally known to , who is personally known to
r;
has me or wk has produced rt VR✓' I C`Q flS' as me or who has produced as
identificatiian and w • did take an oa . identification and who did take an oath.
NOTARY
Sign:
Print:
Seal:
********* *************************************R************#*********************+FBF**** ****ask**********
YANADY PRI
M MISSION # F 031
EXPIRES: March 25, 19
Ag ....... Bonded Thru PYAary PuG�: Undemia.ve
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Zoning
Structural Review Clerk
MARYBELL RAJO
1160 NE 98 STREET
MIAMI SHORES, FL 33138
305-609-0091
Miami Shores Village
Building Department
10050 NE 2 Ave
Miami Shores, FL 33138
RE: PERMIT NUMBER FW -10-17-2524
TO WHOM IT MAY CONCERN:
I AM THE HOMEOWNER OF 1160 NE 98 STREET, MIAMI SHORES, FL 33138. I AM
HEREBY REQUESTING THE CANCELLATION OF PERMIT NUMBER: FW -10-17-
2524. I HEREBY ATTEST THAT NO ACTION HAS BEEN TAKEN ON THE PERMIT
AND NO WORK HAS BEEN PERFORMED WITH REGARD TO THE PERMIT.
THANK YOU FOR YOUR PROMPT ATTENTION TO THIS MATTER.
SINCERELY YOURS,
MARYBELL R JO
STATE OF FLORIDA
COUNTY OF BROWARD
BEFORE ME, the undersigned authority, personally appeared MARYBELL
RAJO, who is '[personally know to me or who produced
as identification.
SWORN TO AND SUBSCRIBED before me this L) day of NO\I&'r1beC
2017.
1 Iwo Poi CA L(_
NOTARY PUBL C
MY COMMISSION EXPIRES:
1602A -Th
DANIELLE BARBARO
NOTARY PUBLIC
STATE OF FLORIDA
Cama* FF101601
Expires 3/23/2018
BUILDING
PERMIT APPLICATION
BUILDING ELECTRIC
(PLUMBING
JOB ADDRESS:
City:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
ROOFING
MECHANICAL ❑ PUBLIC WORKS
f/ /E W <C Y
R CF -INT ED
OCT 24 2017
By
FBC2Oa4s1h
Master Permit No."c-C-1-'---/L-7-5-
t
Sub Permit No. TUJ 11 Z J 24
❑ REVISION ❑ EXTENSION
❑ CHANGE OF
CONTRACTOR
❑ CANCELLATION
RENEWAL
❑ SHOP
DRAWINGS
Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:
Occupancy Type: Load:
Construction Type:
OWNER: Name (Fee Simple Titleholder): / A -/-y/3 ,L,
Address: /2&) X.iE- c?'
Is the Building Historically Designated: Yes
�AA!!,` Flood Zone: ,,� BFE:
f1v`cfe)/ .O�.0cEs �Jl Ph ne#:
NO
FFE:
City: / e 4464 ,S "t(--‘4<!--€7State: re -C. Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: T u.s4-TOL.f
Address:
City:
Qualifier Name:
-/ ¢Z ��/ �.�c �v 6¢ C5 /C/P
/Z' / State:
•i lC_ 1;Z-5
Phone#:300— ?5, 3t??
Zip: 33/ 7?
Phone#: l 3Z co??
State Certification or Registration #: C_/5 'S 7 ) Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: $560
G �� Square/Linear Footage of Work:
l
Type of Work: Addition I Alteration ❑ New ❑ Repair/Replace
Description of Work:
State: Zip:
2cc J ,FES C T sz.
/9.7 c,iAJ Fr
n Demolition
Specify color of color thru tile:
Submittal Fee $ G`) 0 \o iC 1} —7 4 Permit Fee $ 4 1 CCF $ • ZO co/cc $
Scanning Fee $ 9 Radon Fee $ DBPR $ 2..2-1 Notary $ S
Technology Fee $ (j - (C3 Training/Education Fee $ 1 . 1 0 Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $ Q
TOTAL FEE NOW DUE$ tZ ! I
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 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
The foregoing instrument was acknowledged before me this
(d -day of V � , 20 , by
/(' /bd/ K40 , wh
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Seal:
' 1.1-jr,," NOTARY PUBLIC
STATE OF FLORIDA
Conren# FF101801
Expires 3/23/2018
**************************d********************************************************************************
`N -
Signature
CONTRACTOR
The foregoing instrumentwasacknowledged before me this
2L4dayof 0T , 20 17, by
who is personally known to
me or who has produced 0 CO
identification and who did take an oath.
NOTARY PUBL C:
Neurrlidhop
Sign.
Print:
Seal:
as
MY COMMISSION # GG 044602
.''f,it;°t• Bonded Thru Notary .. ,
Public Underwriters
APPROVED BY
Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk