EL-10-260e • :.
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Electrical /�
Owner's Name (Fee Simple Titleholder) M Q i k P' Terry Phone # e °- 2 .0
Owner's Address 3 9 9 Pe ®Z &-r
City I', I G m i State FL. zip '63 13
Tenant/Lessee Name Phone #
E -MAIL: / �
Job Address (where the work is being done) ,"77 /✓6 /dl =7 : j i-02L,i y 2 35/3r
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # I / — 32-0(42 013 — 5- o 8 0
Is Building Historically Designated YES NO
Contractor's Company Name ro aJ'4 I fit„) Sect y i hone # 30S= yC)(.• c3it-10
Contractor's Address g4R/ /U(..) /14s-r /01
City Dori, k State PL.. zip 3312-(p
Qualifier Name )pt 419a S BQS3 &I Phone #
State Certificate or Registration No. 6 000c) 4a- I Certificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if app 'tab
Value of Work For th ' rw lrir€ 3D55. 00
Type of Work
Describe W
Structural Review. $
Addition
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
['Alteration
Submittal Fee $ — 51)
['New
Permit No. J O - Q
Master Permit No.
Phone #
Square / Linear Footage Of Work:
LtZMIE E�
Al FEB 1 9 2010 (ijJ
BY:
❑ Repair /Replace ❑ Demolition
*******. .... * * ** * * * * * * * * * * * * * * * * * * * * * ** F ees * *xxrxx * * *** *xxxxxx ** x oYwx eYzaYl ** ** *9e*****
Permit Fee $ / 'e" ®[� OL
CCF $ i. CO/CC
' O Notary $ Training/Education Fee $ 0 Technology Fee $ 1 -WO
Scanning $ b' `/ 0 Radon $ DPBR $
Bond $ Code Enforcement $ Double Fee $
Total Fee Now Due $
Zoning $
S �
�� V
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 de vered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must . posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence o such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this J)8
day of ,20( , by MO, v1.< - Terry
who is personally known to me or who has produced
As i
I - .
!1 ,96 f: l . _;
NOTARY PUBLIC:
Notary Public Slate oP Florida
Jazmin Loom Commiion DD877396
o , p oi Expires 04/ss08/2013
I i i��
Sign „,
Print
M / ommission Expires:
xrxxrx
APPLICATION APPROVED BY:
(Revised 02 /08/06)
Signature
xxxxx * *xrxxxxxxxxx * *xxxxrx* xx W xxxxx rxx x xxxxxx xxxxxxxxx *x
Contractor
The foregoing instrument was acknowledged before me this
18
day of b , 20 0, by DOU5CiS S
who is is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBL
11
Noel Publla Blatt of Florida
Arlin dopers
My Commission DD877398
rpirp" 04/05/2013
Sign:
M • Commission Expires:
* xxxxxx *xrxxrxxxxxxxx *zxrxxxxxx *xxxx **
Plans Examiner
Engineer
Zoning
Building Official
Village of Miami Shores
To whom if may concern,
FFICE OF MARK TERRY, ESQ.
RE: Permit EL -2 -10 -260
Address: 349 NE 102 St.
Case No. 10 -10 -7841
I N T E L L E C T U A L P R O P E R T Y
Please cancel this permit since no work was done on the property under this permit. Also,
because the permit was expired, I received a notice of violation. Please cancel this notice or
inform me as to what I must do to cancel this violation. Thank you.
Sincerely,
ito
M T- , Esq.
Board Certified Sr
801 BRICKELL AV, SUITE 900 • MIAMI, FL • 33131
PHONE: 786- 443 -7720 • EMAIL: MARK @TERRYFIRM.COM
FAX: 786- 513 -0381 • SITE: WWW.TERRYFIRM.COM
Nov. 29, 2010
Via Hand Delivery