FW-04-21-973 CanceledMiami Shores Village RECEIVEIJ
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Bi"—
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION CANCELLECS05)7624949 FBC 202-0
BUILDING re-Pl °`CA'ci by Master Permit No.�y4-D4 21_ 0193
�W-ro Zy-2�q9
PERMIT APPLICATION Sub Permit No.
QBUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 100 NE 101 Street Miami Shoes, FL 33138
City Miami Shores County Miami Dade Zip:
Folio/Parcel#: 11-3206-013-2020 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ( E`r Y Q�-�l Y�-SPhone#:3�5-2t%10�1957
Address:
City: State: f Zip: 33/34B
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Henry's Fence Inc Phone#: 305-669-0180
Address: 3931 SW 63rd Ave
City: Miami State: FL Zip: 33155
Qualifier Name: Henry P Villoch Phone#: 305-790-0180
State Certification or Registration #: Certificate of Competency #: 93BS00524
DESIGNER: Architect/Engineer:
Address: City: State: _Zip:
Value of Work for this Permit: $2400.00 Square/Linear Footage of Work: 80
Type of Work: N Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 6' HIGH PT WOOD FENCE
Specify color of color thru tile:
Submittal Fee
Scanning Fee $
Technology Fee
Structural Reviews $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Training/Education Fee $
Notary $
Double Fee $
Bond $ _
TOTAL FEE NOW DUE $ _
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lenders Name (if applicable)
Mortgage Lender's Address
City
State
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.
�Signatu aM:J -
OWN or AGENT
The foregoing instrument was acknowledged before me this
dayof fprI L 20
-T. ras r
' (R(Y� is SOIN pr1, who is personally known to
me or who has produced AL � L as
identification and who did take an oath.
NOTARY PUBLIC:
� _
�i..�y—t
SELENA ARANDA
MY COMMISSION # GG 971705
APPROVED BY
Signature
CONTRACTOR
The fccfggwoing instru ent acknowledged before me this
11090 day of 20 ZI , by
Henry P VIIIOCh , who is personally known to
me or who has produced as
identification and who did tak�t p�OS R00 Z��i
NOTARY PUBLIC: Ilr0*�'.•�sl/��y
q--4�
Print:
i �� • , e Unde
Seal: 'fir/i i� STATE OF
Plans Examiner
(Revised02/24/2014)
Structural Review
Clerk