SGN-17-1552 Miami Shores Village RECEIVED
Building Department JUN 25701
,g�&
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20 t-I
'BUILDING Master Permit No. SUN lI - ISS2.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [—]PUBLICWORKS ❑ CHANGE OF ❑■ CANCELLATION [—] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9545 NE 2nd Ave
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-013-3910 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): DVS LLC Phone#:
Address:201 NE 95th Street
City: Miami Shores State: FL Zip: 33183
Tenant/Lessee Name: Dunkin Donuts Phone#:33138
Email: rn
CONTRACTOR:Company Name: Sign EffeX Phone#: 8632944498
Address: 512 Sixth Street NW
City: Winter Haven state: FL Zip: 33811
Qualifier Name: James. P. Richard Phone#: 813-404-9207
State Certification or Registration#: EC0000562 Certificate of Competency#:
DESIGNER:Architect/Engineer: David Norris Engineering Phone#: 863-299-1048
Address: 112 Coleman city: Winter Haven State: FL Zip: 33880
Value of Work for this Permit:$980.00 Square/Linear Footage of Work: 35.7
Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition
Description of Work: Cancellation for SGN 17-552 Permit (East Elevation )
Specify color of color thru tile:
Submittal Fee$ 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)
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 Ilp
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 tie 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 doneIn compliance with alf f
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE'OF COMMENCEMENT'MAY
RESULT IN YOURPAYING 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 wthe issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith thdra copy of the notice of comrnenceinent,ond construction Nen low 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. M the absence of such posted notice,the
inspection will not be oppr edvird 7#1risp than fee will be charged.
Signature Signature '
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this the foregoing instrument was acknowledged before me this
f day of 020
by day of� •T,t�; • ,..,20 by
who I is'personally known to .JarheS P. Richards, Jr. who is personally known to
.�or who has produced as me or who has produced as
identification and who did take an oath: identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC �
1
Sign r' Sign:• , ` safJ i
Print: . ,! e° Print: i
,e
Seal:
ELIZABETH ELORRIAi3A Spai -� *: MY'COMMISSION#GG004387
?n. EXPIRES Julie 21,2020
y MY co ISSlONaltFf9=36 f Lt)388O�S1 f1Dwarvotsp5wv..e;.
•,or
EX01RES11uary 25,2M
ti*#wii+ti#ii. £lY�i1HY1RWiki#iii- �,i.,R. *.f#iii#ilii#ii#i##+ti#*+►Atiii#lit*##ii#i#t#i*iii*#i+Yti#i+�ti#y##* '
APPROVED BY Plans Examiner 'Zoning
Structural Review Clerk
(Revisedb2124J2014)