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RC-01-23-1 CancellationMiami Shores Village 0 Building Department MAY I S 2023 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 202Ao BUILDING Master Permit No. C.—Ot—Z`3 ` PERMIT APPLICATION Sub Permit No. ©BUILDING ELECTRIC ROOFING REVISION EXTENSION ORENEWAL ®PLUMBING ® MECHANICAL ® CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: P'1 \'S+ Citv: Miami Shores County: 1 Miami Dade Zip: —3 ` M 11 0 2vu 4V Folio/Parcel#: i� 7iZ � LC7 3 Z � Is the Building Historically Designated: Yes NO ✓ Occupancy Type: Load: Construction Type- Flood Zone: EFE: FFFE: 1 OWNER: Name (Fee Simple Titleholder)-- 1�O"V\ f'F � C}Lj y j Phone#: 1 Address: Z l tj C j d \ 0. \ 3'31 8 City: � �� F� J K�- State: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name:: Phone#: Address: Email: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 2 S � 006, 0 Square/Linear Footage of Work: Type of Work: Addition 0Alteration New Repair/Replace Demolition Description of Work: &�A`'c,0n Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ DCA Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ i Double Fee $ Structural Reviews $ _. P&Z Review $ Bond $ TOTAL FEE NOW DUE $ (Revised04/05/2022) Arlenis Silvera From: henry dow <henrydow@hotmail.com> Sent: Thursday, May 18, 2023 10:40 AM To: Arlenis Silvera Subject: 1421 ne 104th st Want to cancel permit app and review process. Please schedule inspection. Henry Dow Sent from my iPhone Miami Shores Village ENS nno D BUILDING PERMIT APPLICATION Building Department JAN Uri Z023 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY. - Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FFBC 20 Master Permit No. I? C - 01 - Z3 - Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP `, CONTRACTOR DRAWINGS JOB ADDRESS: I A(R f N O ST City: Miami Shores County: Miami Dade Zip: 33139 Folio/Parcel#: I (2.2,-3Z p3Z ©Io Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): fA E-NPRi 1�10W Phone#:q�tl H 1 ✓ 2[ II Address: 1'{! 1 n f IO-q S-r City: n-LI,gMI S(lb"s State: Zip: 33139 Tenant/Lessee Name: /V J'a Phone#: ?V /14 Email: �C1�D►UW:nE22LS`f1ri�LAtlQn) �RaUp• cD CONTRACTOR: Company Name: �� A Phone#: Address: Email: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: 7UA N L - `� IiJ k1N Phone#: 3V5 295 "13 A13 _ Address: I'Z555 CO(2-Al— W A-1 SCT� t - fn+ City: kA l Ate( State: zip: 33 1 VS Value of Work for this Permit: I,��(,1� • Square/Linear Footage of Work: I, �� 41 Type of Work: 1A Addition LJ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1 �eLL(Q(L 53 ��112[02 (mP� Bd�(1"t//Y] fY1'�InP 'lGY1d Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised04/05/2022) Permit Fee $ DCA Fee $ Training/Education Fee $ CCF $ DBPR $ P&Z Review $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature L OWNER or AGENT The foregoing instrument was acknowledged before me this day of -t5 EGe rv\ e ✓ 20, by r° irYi*I Uvi who is p to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign Print: 3�4,S\ I �6mcge,� o�igY A�BG DEYSI J. SANCHEZ Seal: Commission # GG 312634 .gy �a Expires July 12. 2023 %Iw Bonded Thru Budget Notary Servlcos Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of me or who has produced J 20 by who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: as APPROV��(�.P��,PlansBY Examiner Zoning Structural Review Clerk (Revised04/05/2022)