DGT-10-1101BUILDING
PERMIT APPLICATION
C 20
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax; (305) 756.8972
INSPECTION'S PRONE NUMBER: (305) 762.4949
Permit Type: BUILDING ROOFING
Owner's Name (Fee Simpio Titleholder) C �E i i4Et.. Phone # 7. C:)
Owner's Address "3 't N E Y i ST.
C i t y M t A t-A \ SO oLES State F k_o
Tenant/Lessee Name
Value of Work For this Permit $ 600
Type of Work; DAddition QAlteration
Describe Work: A R J 0
Training/Education Fee $
DPBR $
Zip
Email \ E FF - S F `i Et- Q S B C. ci Mr-
J Q ';499 -tka 5pe. loba.l
Job Address (where the work is being don) 1 e t 10 t ST
City __Miami Shores Village County Miami -Dade + __,dip
FOLIO / PARCEL # - 32.06 13 5100
Is Building Historically Designated YES NO
J
Submittal Fee $ Permit Fee $ !CCF $
'33 t
Master Permit No.
Phone #
Permit Noi,' iQ - 110
JUN
t5 ° 1 666
Contractor's Company Name V V J K` S tS LI t p
Contractor's Address
City
Qualifier Name
State Certificate or Registration No.
Contact Phone $ ' 3 ' " LC '
J eW tce
Architect/Engineer's Name (if applicable)
Phone #
Certificate of Competency No.
i C J o - etS' e
Phone # .� c3 6 . 3 8:z - 16°A5
Square / Linear Footage Of Work: '70
New 0 Repair/Replace 0 Demolition
* * ** ;* X ** * * ** * * * * * * * * * * * * * * * * * * * * * * * ** *p **** * ** ' ** ** *x ** Ott * * * *4.- ** * * *** * * ** * * ** **
CO /CC $
Notary $
Scanning $ Radon $
Doublb Fee $ Violation date:
Structural Review. $ Total Fee Now Due $
Technology Fee $
I3ond $
See Reverse side a
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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 ofa 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 insp tior which occurs seven (7) da s after the building permit is issued. In the absence of such posted notice, the
inspection will nab- ; ' proved a • • einspectief ill be charged.
Sign:
Print:
Contractor
The fore oin ` nstru,ment was a � . dged r: this The foregoing instrument was acknowledged before me this
�n
j,(►i.0 b
day of ` 2t! � � - '� � day of , 20 i, by
who is p natty known to me or who has • roduced who is personally known to .me or who has produced
"Ir t UC 4.1 As identification and who did take an oath. as identification and who did take an oath.
NOTARY J: i NOTARY PUBLIC:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * **
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
State
Zip
''''' JEFFREY B. PRICE
- -
*
Plans Examiner
Signature
Sign:
Print:
My Commission Expires:
Zoning
Engineer Clerk checked
deft
319 ne 1O1 street`
Miami shares, fie. 33138
203 387 9612
Dee ores I
� gG3EB�7g
P9nR o 4 2011
BY: e.ev_C�J�
It has corns to my attention that a permit .
Permit # T10 --1101
ne 101 street
Ido not recall ever applying foxed ► s3
which is already down. 1 neverr any intention of buil&
Please cancel ittie perm it ehd if you id 8160 please send
Thank ; u very much,
,
l ken out on 31 9 +;101 51 street Imi shores last June,
I nything other than ' the °'w °* a
r
do :1 ever, N deck has ° built,
a copy for my'fil