RF-17-1738lq
-A49/Prl.
BUILDING
PERMIT APPLICATION
XBUILDING ❑ ELECTRIC
❑ PLUMBING ❑ MECHANICAL
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
❑ PUBLIC WORKS
JOB ADDRESS: AZ—S-9 9g 4772E6.7"
RECEIVED
JUL062rU1I
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FBC20i
Master Permit No. ) 1938`
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
County: Miami Dade
Zip: 2308- 2-1-64._
Folio/Parcel#: // 320. 007- 0260
Is the Building Historically Designated: Yes NO )
Occupancy Type: Load: Construction Type: as Flood Zone:
BFE: get) FFE:
OWNER: Name (Fee Simple Titleholder): DA, T csE Phone#: 604) 7-1-4- 2 772
Address:/2-Sj /)6 q& s-rArzzr
City: kf A .S`to&es
State: FA-c3R-164
Tenant/Lessee Name: AO)
Email: dRJf cst%CO 'Ie.((sow , •Nd. ANCELLE
CONTRACTOR: Company Name: A rce-MA9fc CcwrliZte1C ra s, _-. Phone#: 60,$)
65-2-.3'3'
8s ii e /Ps- s7 t- -f4ay
City: M//9M / State: rcc,R/4A Zip: a:317?
Qualifier Name: J sEPH /9, L/700re4 Phone#:
State Certification or Registration #: CCG /3a,$ -?6-3 Certificate of Competency #:
DESIGNER: Architect/Engineer: a Phone#:
Address: 1 City: State: Zip:
Value of Work for this Permit: $ /24-0, 0 c' Square/Linear Footage of Work: .48c ce7- /7/0 S--
Zip: -33138-2562
Phone#: 0°4) 7r 2772 -Ices
�3ol) 331-/692--
Tenant/Lessee
I6`l2-
Address:
Type of Work: ❑ Addition ❑ Alteration New jg1 Repair/Replace n Demolition
Description of Work: koc»C emile.s a"f Svu' tkie-si �, (e& sf i'c.J�e)
Specify color of color thru tile: 16
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
CCF $ CO/CC $
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) 1v
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 YOAR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT." (.44/
,
Notice to Applicant: As a condition to the issuance of a building permitw n imated value exceeding $2500, the applicant must
promise ingoodfaith that a copyofthe notice ofcommencement and co( lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded n 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 . inspection fee will be charged.
Signatur:
2
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of ST_.f"--CL—_ , 20 ( 7 , by
-5-6{ t-1 , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: Alakt f iai:; sa =¢ t8
•
Seal:
egos
s
tc`t a
V im• -
i�jvOTARY �0i� .
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**************************1'******,*****,*******
APPROVED BY
(Revised02/24/2014)
tz./4
Signature
CONTRACTOR
The foregoing instrumentwasacknowledged before me this
£i day of UvL" om`P p , 20 !� , by
LI- taersonally known to
me or who has produced `(--L -D2.1 (k.0 a-
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
Structural Review
a Pifc � SiSindnd l�ti'®IfE S )e o) F(ori�a
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My C6nflI Nigh FF 156750
-.o.aw Expiresd9Ij312018
Zoning
Clerk
CONTRACTORS, INC
ROOFING DIVISION
State Licensed General Contractor, License Number: CGC014838 — Since 1979
State Licensed Roofing Contractor, License Number: CCC 1325963
285 N. E. 185th Street — Suite # 24
Miami, Florida 33179
October 2, 2017
Office: (305) 652-0300 Cellular: (305) 968-6932 — Koby
Telefax: (305) 652-9545 Cellular: (305) 632-3103 — Joe
www.affordableroofingcontractors.com
Building Department
Miami Shores Village
10050 N. E. 2nd Avenue
Miami Shores, Florida 33138-0000
Re: Roofing Permit Number: RF -7-17-1738
Dr. and Mrs. J. Rose
1259 N. E. 98th Street
Miami Shores, Florida
Dear Sir or Madam:
Please cancel the above referenced roofing repair permit. The customer has requested that he be
allowed to contract with another firm. Our firm did not perform any work.
Sincerely,
Affordable Contractors, In.c.
Joseph A. Litowich
, IN
295 N.E. 185 STREET • SUITE #24
MIAMI, FLORIDA 33179
OfIgt14.1f FL 331
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