RF-09-985BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Building Rodin
Owner's Name (Fee Simple Titleholder)
Describe Work:
6gss -
Architect/Engineer's Name (if applicable) h (t.
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) - Pt 1 1
Value of Work For this Permit $ 1 2, bOO
Type of Work: ❑Addition ❑Alteration
Miami Shores Village
JUN 11 2009 Iljj
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Permit No. ky l l`"6
Master Permit No. `Oq - 6
b -ems 1
Owner's Address 0
City 1 ��VC"Y01 or. State FL Zip
Tenant/Lessee Name Phone #
Job Address (where the work is being done) I act? 1 qS S
City Miami Shores Village County Miami -Dade Zip .T 19
FOLIO / PARCEL # II- $20S --0i2.,- 001 0
Is Building Historically Designated YES NO
Contractor's Compan gNamee All in ON... T lO t' �1( klNC 1 Phone # t C� 4 • • V cal
Contractor's Address 1Q�O N 9 S •
City MID/hi State
Qualifier Name i . f••tcit0 j
State Certificate or Registration No. Certificate of Competency No. • �� VVO�
Rco-c' fir am qr4d11)e0
******** ** * ** ****** * * ** ***** * ** ** *** Fees******* e**** * ** *** ** ** *** * ** * ** * **********
r M �
Submittal Fee $ Permit Fee $ //��
Notary $ Training/Education Fee $ ca.4 V
Scanning $ (71. Radon $
Bond $ Code Enforcement $
Square
Phone #
Zip 3 311
Phone #
❑New
❑ Rep=
Phone # 5 J t i
CCF $ / nC
Technology Fee $
Qf Work: 52)0 0
BY:
❑ Demolition
DPBR $ Zoning $
Double Fee $
Structural Review. $ Total Fee Now Due. $ t9n u 'CD
See Reverse side --,
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's 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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 abse ' e f such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Sign:
Print:
s it
Owner or Agent / Contractor
The foregoing instrument was acknowledged before me this ` / P' / fie f Th oregoing instrument was acknowledged before me this
day of , 20 _ , by , - day aft 1I I "" , 20 _, by ,
who is personally known to me or who has produced who is pertly kno‘ . o me or who has produced
/ ' entification and who did take an oath.
As identification and who did take an oath.
NOTARY PUBLIC:
on #DD766456
a;,11 W T2 6Vi.oiuDA
lir L.nT: :CO In/
My CommissiltROOMMentiNEWEIS eel ere My Co trig MAR. 10, 2012
Nw eee,,nve,
********************************************** ** ***: x** ************ ** ***** **** ***: x** ******* * ******e**********
APPLICATION APPROVED BY:
(Revised 07/10/07)
Signature
NOTARY PUBLIC:
Plans Examiner
Engineer
Zoning
Sep 07 2010 9:24RM ORONI INC 305 - 688 -9550
(1k(b\tte-c21)1
09/03/2010 17:13 7863538955 ALL IN ONE P S INC
Sep Ud Pti1U 2 :85PM CRONI
IM C
ILL -IN -- ONE Pleffarf
13241 Nat 3 Ct. M1 ni FL 33161
3O541934OOF
September 1. 2010
Ref: Permit # RF 6 -9 -985
Adams Project
1098 N.E,:0.5 St*
To Whoni It May Concerns
Please cancel the alp :We referenced permit, No work
or inspcctions havc i3ceu pvrfuiw d under the above
referenced permit. h is to be replaced with the
por snit i ouq d. to* Quality Yttxsvl"urg. It ftF 10 -963
Thank you.
306 -688 -8550
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