FW-09-2070BUILDING
PERMIT APPLICATION
FBC 20
Job Address (where the work is being done) 0 it/g, 1 3
City Miami Shores Villa • e County Miami -Dade
FOLIO / PARCEL # 4 0(5 460 400 10
Is Building Historically Designated YES NO
Contractor's Company Nam
Contractor's Address
City
Qualifier Name
n
Value of Work For this Permit $
Type of Work: ❑Addition
Describe Wor /
:,COA,
State Certificate or Registration No.
Notary $
Scanning $ (D' CD
Double Fee $ Violation date:
Structural Review. $
Miami Shores Village
Building Department
FECEIVED
j 2OQ 3
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit NoS to - 9
Master Permit No.
Permit Typ y! UILDING ROOFING •
Owner's Name (Fee Simple Titleholder) F/14/6 1 0:474/Z Phone # .T/ 451.3.t.25
Owner's Address 90 k) 0c) 5
Tenant/Lessee Name AI A
cit Sh P6/4
Phone #
Email
unkitk - Ey /AIL
Phone #
Zip 33/3 g P 'c®
Flood Zone
State Zip
Phone #
'Contact Phone
E -mail
Architect/Engineer's Name (if applicable) Phone #
Training/Education Fee $ 0
Radon $ DPBR $
Square / Linear Footage Of Work:
❑New ❑ Repair/Replace Demolition
91P p 6 4 .(4
6
* * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $2.03
Permit Fee $ /O ®°w CCF $ 0'(./2,0 Cc_
Technology Fee $ V' ND
Bond $
Total Fee Now Due $ 5
See Reverse side —
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) A-
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.
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
"WARNING TO OWNER: YO 4 LURE TO RECORD A NOTICE OF
COMMENCEMENT MY RESULT ?3 - YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH ,y O UR LE AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF CQMMENCEMEN
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 Signature
®wn Agent ®�® Contractor
The foregoing instrument was ack el`d'ged before me this 1 ' The foregoing instrument was acknowledged before me this
day ofiffeLe04, 201) al , by D1 T f4 Q day of , 20 , by
who is personally known to me or who has produced who is personally known to me or has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
0 0,11 1uliitr,,, ,
Sign: _ `\ ., Sre ,.
Print: _ 0310 @ ue`1 C
My Commission Expires: _ ; �o�{� 16$0011 4 :
a,;e' /�—/A p Plans Examiner
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
/d4
C 7 Zoning
Engineer Clerk checked
Miami Shores Village Building Department
10050 NE 2 Avenue
Miami Shores, FL 33138
Permit #: FW -12 -09 -2070
Requested by: Mark Franco
Dear Mr. /Mrs.,
I hereby request the closure of permit # FW -12 -09 -2070 for construction of a wall on the east side of my
house located at 90 NE 106 street in the Village of Miami Shores. The reason for my request is due to
my decision of not build the wall where the gate is located.
Thank you for your time and consideration.
Sincerely,
0_a(c) Li2(p
Mark Franco
00 011 111 1114
/2.cpxo
pCMW3n
FEB 2 5 2010
BY: �....
Mark Franco
90 NE 106 Street
Miami Shores, FL 33138
February 25, 2010
CANICELL2D