RF-18-3274 (2)S� RES h
yam- CHECK REQUEST FORM
50�
fi� Rim
VENDOR NUMBER DATE: March 8, 2019
MAKE CHECK PAYABLE TO: SUN LIFE ROOFING
PLEASE INDICATE MAIL CHECK: YES NO X
MAILING ADDRESS: 11455 SW 40 ST #333
MIAMI, FL 33165
IF "NO" GIVE CHECK TO: BUILDING DEPT
AMOUNT OF CHECK: $ .
ACOUNT NUMBER
AMOUNT
Permit— 00 1 -24-0400-00-322-000
Scanning
Education Fee
Tech Fee
REASON FOR REIMBURSEMENT: 50% of permit fee reimbursement due to
permit cancellation — RF-10-18-3274
c: D--� I (III Ct .
CHECK REQUESTED BY:
DEPARTMENT HEAD ISMAEL NARANJO
RECEIVEL)
WA
11455 Southwest 40 Street #333
Miami, FL 33165
Office (305) 800 - 7663
PERMIT REFUND REQUEST
Date: '3 / -7 / 0,01-I
Reference: Contractor Name:
Permit Number: K E ` ( 0 - P D - 31 _7 1-+'
MAR 0 8 Z019
Jobsite Address: n - I �53 N E- -1 owe -c wi 1 ci i S � S, _�t 33 (3 Cj
Cancellation Reason:
Contact Name: Da
Aj L r4
Phone Number: l / XL, ) K / -%
Refund Amount: $ a00. 0D
Please be advised that the above referenced information is to request a permit refund. I understand that the UPFRONT FEE, the
Miami -Dade CODE COMPLIANCE FEE and the STATE OF FLORIDA RADON FEE are non-refundable. I also understand
that the refund must be more than $ 100.00. Attached you will find a copy of the permit card stating all payments made.
Should you need further information, please contact the above referenced contact at the phone number indicated.
Applicant Signature Notary
State of Florida, County of Miami -Dade
Sworn and subscribed to me this:
IMafch 0-1 'A01 of
Month Rav Year
Personally Known r Identification:
(Type of ID and expiration date)
Da V t . I3eceZ
Printed Name of Applicant
:�^` • YANAY PEREZ
Notary Public Stamp: My COMMISSION 9 FF926538
EXPIRES October 12, 2019
RECEIVED
Miami Shores Village M K 08 2019
Building Department BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (30S) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ROOFING
FBC 20 1:4'
Master Permit No. RF -i d- ( 2 - 327Y
❑ REVISION
Sub Permit No.
PLUMBING [—]MECHANICAL PUBLIC WORKS [:]CHANGE OF
CONTRACTOR
❑ EXT SION
CANCELLATION
❑ RENEWAL
❑ SHOP .
DRAWINGS
JOB ADDRESS: Oq S3 NE q nW 2A
City: Miami Shores Count : Miami Dade Zip:
3 313 8
Folio/Parcel#: 1 13 aQ60 q 60yao Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Sir) G [ Phone#:
Address: SCA153 N E f_ 4 -Blue RA
City: IQM'� l 'S �.iJ�Q State: L Zip: 3309
Tenant/Lessee Name:
Email:
ne#:
CONTRACTOR: Company Name:
�J �L`� 6���\Ing;Wlo 'P- Phone#:(30�) x—�t�3
1-4Address: �7 w 0 5T,
City:'M (CIAM 1 S- e S State: Zip:
33I3� g
Qualifier Name: L J `�2,(QZ Phone#: ( / K6ll ) [rn-9193
State Certification or Registration #: ccc 133o3(LI Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
City:
ne#:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑, Algeration ❑ New ❑ Repair/Replace
Description of Work:
r`/.-�'^.'
'Specify color.of,,color.thrulile:
Submittal Fee $` !:Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
Zip:
❑ Demolition
CO/CC $ _
Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $ _
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address '
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City + State
Zip
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 is In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signatu
OWNER or AGENT
CO
v {
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20. by day of A011A 1
f 8 20 J by
who is personally known to who is personally known to
me or who has produced
as me or who has produced k D10%Et as
identification and who did take an oath.
identif
and who did take an oath.
NOTARY PUBLIC:
rtion
NOTA
PUBLIC:
Sign:
Sign:
Print:
Print---'
Seal:
Seal:
M. SINDIA ALVAREZ
MY COMMISSION # GG 238273
.;
;•. •�;' EXPIRES: September 3, 2022
s+.fof.;° Bonded TMuNotaryPublicUndetmiters
APPROVED BY
0 r/
Plans Examiner
Zoning
Structural Review
Clerk
(Revised02/24/2014)
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
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC Q ROOFING
CT 2 ql 201
BY:--
�'`
FBC 20 2
Master Permit No. g� I � — 3Z,14
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 8953 NE 4 AVE RD
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-046-0420 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Types Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):SHAWN C
Address: 8953 NE 4 AVE RD
City: MIAMI SHORES
Tenant/Lessee Name:
Email
State: FL
CONTRACTOR: Company Name: SUN LIFE ROOFING CORP
Address: 11455 SW 40 ST #333
Zip: 33138
Phone#:
Phone#: (305) 800-7663
City: MIAMI State: FL Zip: 33165
Qualifier Name: DAVID B. PEREZ Phone#: (786) 873-9183
State Certification or Registration #: CCC 1330314 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: nn p City: State: Zip:
Value of Work for this Permit: $ d `5.Ot7 Square/Linear Footage of Work: V 1
Type of Work: ❑ Addition ❑ Alteration ❑ New ■❑ Repair/Replace ❑ Demolition
Description of work: SHINGLE RE -ROOF
Specify color of color thru tile:
Submittal Fee $ SO t Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $��
i
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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 IMP VEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."PA
Notice to Applicant: As a condition to the issuance of a building pet t it an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement an tion lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the reco 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 t absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
f�
Si ur Signature
_ )A
OWNER or AGENT 0 TRA TOR
The foregoing instrument was acknowledged before me this
l Q'
day of 20�0 by
flLo who is personally known o
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
n ,
Print:
Seal: �pW 0 Notary Public State of Florida
Felix Giralt
My Commission GG 221650
Expires 05/23/2022
********** * * * * * ***********
Lz./-S
APPROVED BY
The foregoing instrument was acknowledged before me this
11 day of ,r'0.T i&tJ0 r 20 �, by
avid 3•'Perez who isto
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: `�
Seal:i
r,
Plans Examiner
Structural Review
YANAY PEREZ
MY COMMISSION # FF926538
EXPIRES October 12, 2019
as
Zoning
Clerk
(Revised02/24/2014)