RF-07-1533To: Miami Shores Village Building Dept.
1005 NE 2 AVENUE
Miami Shores, FL 3310 -0000
I Louis Toledo qualifier of T &S Roofing Systems license # ccc1326032 would like cancel permit #
RF -7 -07 -1533 at 142NW 94 ST. No work was done in regards to the permit, and customer was refunded
money. If you have any questions feel free to contact me at 305 - 265 -2654.
Thank you,
Louis Toledo
President
Office: 305 - 265 -2654
Fax: 305 - 265 -2685
Email: Iouis @tsroofing systems.com
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BY:
-r44,I S :31 OF
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATIO11 JUL 2 3 111:11 JkJ
Job Address (where the work is being done)
City Miami Shores Village
FOLIO / PARCEL #
Is Building Historically Designated YES
Contractor's Company Namel ( " * Pi - )-Crtal
Contractor's Address (1 I et Dkof
City pi G.
Value of Wprk FotAtin-Atr '
iitmil It WE' 41:citsq voloN
30 ,S
Type of Wok: PCOASfitirlitattrim
i li k
C hit. elvolx 3 emAmol
ain
Describe Work:
Submittal Fee $
61/40 1110
FBC 2004
BY:
Permit Type (circle): Building gli iiftariffirlI alilkpopMarlo
Owner's Name (Fee Simple Titleholder) (3 ( ric ernenv1 Phone #
Owner's Atrfss t q 61-
City 1 Q M State 1 Zip iob
- nen
Tenant/Lessee Name Phone # t?) 51Q
ci
Permit No. lC ia)
Master Permit No.
MINIPIMIN11
Qualifier Name_____ Phone #
State Certificate or Registration No.'&(,CQ Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
4 CCF $ (0 (00 CO/CC
Notary $ Training/Education Fee $ 20 Technology Fee $ /LA"
Scanning $ Radon $
Permit Fee $
Bond $ Code Enforcement $
Structural Review. $
DNew
S3o, Tsev-
Square / Linear Footage 0 W .5 1:o wit tift: witatriusoo
ao 4 acivirmnoa
Repair/Reptaten It
Zoning $
DPBR $
Double Fee $
S Zr CK3qi3
Total Fee Now Due $
See Reverse side ---> AUG 0 1 PAID
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 sefiarate 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 f 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 certed copy of the rccord?d notice of commencement must be posted at the job site
for first inspection which occurs seven (7) days ter the buildin mit is issued In the absence of such
.f .f P () �1' of g p � f posted notice, the P
inspection will not be aproved and a reinspection fee will b ged
Signature
The foregoing instrument was acknowledged before me this
day of l.�+- , 20 (1, by %AC k 'Pe I Ui
h r k ally known me or who has produced
Sign:
Print
My Commission Expire
(Revised 02/08106)
Owner or Agent
e foregoing instrument was acknowledged before this I Fr
y of 206) by vi� ,
own to me or who has produced
Sign:
Print
Commission Expires:
Contractor
As identification and who did take an oath. as identification and who di s take an oath.
NOTARY
My Commission
* **
* * * * A ** *, * * * * * * * * * *** * * * *, , , *, , * ** * * * * * * * * * ** * ** * *, * ** * * ** * * *** *** **** * * *** *,* * * **
APPLICATION APPROVED BY: 7/11/7 Plans Examiner
Engineer
Zoning