RC-10-15-2705 CancelledBUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
Miami Shores Village RECEWED
Building Department JAN2 9 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 Q-41
INSPECTION LINE PHONE NUMBER: (305) 762-4949 co--,
FBC 204
Master Permit No. & 'la- 1,517 -76-5-
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 7(f L V It l D
City: Miami Shores / County: Miami Dade Zip-
Folio/Parcel#: u-0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: , BFE: �-y FFE:
OWNER: Name (Fee Simple Titleholder):t _Phone#:_ ,SVT -
Address: / d Iff sl
�"f r
City:. State: r C. < Zip:
Tenant/Lessee Name: Phone#:
Email: e, (Le lrin
CONTRACTOR: Company Name:
Address: _ Now
City:. 9!
f�
Phone#:
Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #: .
DESIGNER: Architect/Engineer: Phor
Address:. _ ._ _City:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition �y❑, Alteration New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $,
Scanning Fee $
Technology Fee $ _
Structural Reviews $
State: Zip:
❑ Demolition
Permit Fee $ CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $_
Training/Education Fee $ _ Double Fee $
Bond $
TOTAL FEE NOW DUE $ 4ab . co
(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 issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Cy���
Signature Signature
OWNER or AGENT
Thea
nstrument was acknowledged before me this
of ci� � 20 17 by
who is perspnaliy know
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:'
Sign: /A/
Print: Ce,4y 1w
Y _0
Seal: � • �� „�,�
CONTRACTOR
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:
Si
Print:tiIJ1�Lt3Pi -�
Seal:
as
111� APPROVED BY ! 3 1 l� /
%tans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk
Miami Shores Village Hall
Building Department
10050 NE 2nd Ave.
Miami Shores, FL. 33138
Subject: Building permit
01/24/2019
To whom it may concern,
My Name is Edward Miller, owner of premises located at 190 NE 111 St. Miami Shores, FL. 33161.
1 hereby authorize to close the permit # RC- 10-15-2705 pulled to install the solar panels since this job is
no longer needed.
Feel free to contact me if you have further questions at 305-807-4045.
Regards,
A,
Edward Miller.
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
PLUMBING ❑ MECHANICAL
Miami Shores Village
Building Department OCT 2 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 RY_
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 u j
❑ ROOFING
JOB ADDRESS: _ I -1 O %V G' M
Citv: Miami Sho
Folio/Parcel#:
FBC 20 I�
Master Permit No.� CT��
Sub Permit No.
ISION
�RKS [—]CHANGE OF
_ CONTRACTOR
TI
Miami
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
kX L- _ �'�Q fM�1s�
OWNER: Name (Fee Simple Titleholder): id'vEi U Phone#:
Address:
City: 111,�•�l �� 0 rky.j State: Zip: �3
Tenant/Lessee Name:.
Email
Phone#:
CONTRACTOR: Company Name: /tJ.Q 'u p `f4A Phone#: �q 1C2 "n C) O !�-'q 2-
Address: [ A i,-.Q _ n
City: ` 1 State: Zip:
Qualifier Name: Q\ V ' ►V Amy Phone#: �� ��?z1�) �-2
State Certification or Registration #: C� 0 f 3 Certificate of Competency #: q
DESIGNER: Architect/Engineer: RS�-LAN & /3'>71 Phone#: -
Address: S 02 6,V /A�� pm City: LV-t3 State: F I. Zip:
Value of Work for this Permit: $ "l 7 0 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: T 0 (;It
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
[f] New ❑ Repair/Replace ❑ Demolition
St-)l /jy-' ?aAzA -�l
Sa . t'=-+
Permit Fee $ - CCF
Radon Fee $
Training/Education Fee $
DBPR $
any ' 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 issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWN or AGENT
The foregoing instrument was acknowledged before me this
day of by
k - t �`�� who is RQr i kno C
me or who has produced as
identification agd-who did take art oath.
Sign
Signature.
CONTRACTOR
The foregoing instrument/was acknowledged before me this
day of 60L 20 / 5'
, by
r� fA f V, \(t Ir "ntclI, w p csa Ily known to
me or who
Sign:
Print: Print:
Seal: gig*
tate of Florida SeaI:
FF 008637
17
APPROVED BY -2f'i /,+v Plans Examiner
Structural Review
roduced
nd who did take an oath.
J VILMA PERAL.TA
k? MY COMMISSION # EE202251
EXPIRES August 29, 2016
as
td q l ( Zoning
Clerk
(Revised02/24/2014)