DGT-15-3005Miami Shores Village r rvr�-
�` Building Department018
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• 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949 1 1
FBC 201"4 I 0
BUILDING q a r Master Permit No.
PERMIT APPLICATION �L r l � f - Sub Permit No.
BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
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DRAWINGS
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JOB ADDRESS: l J 0 C Ali -
City: Miami Shore County: Miami Dade Zip: 33(so
Folio/Parcel#: I I Z 125 b 0 Q 1-0 30 Is the Building Historically Designated: Yes NO
Occupancy Type:. 2_ ` Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): HAS A#44 tl O m t'i o e Phone#: a" 3 I mAddress: i 0 S Zb o W 2 A J 5�1 yo 0 �*r(
City: LA 04 V-A t S(no2 e S State: `� (_ Zip:,'�'� t �O
Tenant/Lessee Name: Phone#:
Email: 1J�QJQkS�f1 ! FiN AE151► ���/l0� %O 1M
CONTRACTOR: Company Name: Phone#:.
Address:
City: State:
Qualifier Name: Phone#:
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration (❑ New ❑ Repair/Replace / ❑ Demolition
Description of Work: [ A-0 C_Q.� ( 0 tr0 t' 3?��•O/l1 f'�D � G �t2.L Y�y_
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ o' c5z) `
CCF $
DBPR $
CO/CC $
Notary $ 5. (3D
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I (05. w
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
n
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City , ' ' State IZip
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'Applicont. 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 t absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or A N
The foregoing instru nt was acknowledged beforemethis
day of 20 l by
!L�J who is personally known to
me or wh has produced as
identification and who did take an oath.
NOTARY PU LIC: ' - - - """""""`-"`^
Notary Public State of Florida
Jorge Rousseau
1 e My Commission GG 193011
Sign:
91or mop Expires 05104 2022
Print:
Signatu
CO
The foregoing instrument was acknowledged before me this
day of , 20 by
, who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: 1 / - Seal:
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APPROVED BY
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
8-22-18
To Whom It May Concern:
I, Martha Gamallo Martinez, am requesting to cancel permit #DGT1215-3005 as I
have already paid the violation and would like to schedule an inspection to close
the violation.
Sincere]
Martha