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RF-10-752Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 B Y: BUILDING Permit No. 1 f " � PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING OFING Owner's Name (Fee Simple Titleholder)A i SC aF a di ]h(L 1.L. Phone # �Os g 68- ' 2 0 3 Owner's Address 1 1 � - O ! 4& E G ° A R 5� City I'S/v./ 1+ .9(1_ State f L> Tenant/Lesee Name P/- PA p os r 2 Email {P)o L ti v q yl M, j c ALL v i ti . ti.) Job Address (where the work is being done) 824-, City Miami Shores Village County „' ade Zip FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name i Cam° co Contractor's Address /900 s t.o „ City M 1 Qualifier Name M EL % AS Lb State Certificate or Registration No. C C< 1 Contact Phone ( Vh / 3 3 r £ Architect/Engineer's Nam- (if able'►, kVA Value of Work For this ' ermit $ 4-50 • O D Type of Work: ❑Addi,'on Describe Work6) 0 E -mail f Zip LD �� Zk5jhone # 3 51.5 Phone # C7 ,) 344(-- - 5 j o g Zip Flood Zone 6 0.0 253a6 .1 • • [201* *re- M I @itEt_sovrif. N �I Phone # Square / Linear Footage Of Work: :New [� e air ❑Alteration �epla ce ❑ Demolition € A 0045 — "T''D e- ,s'Io tbi:.Li-1 /AS 14 f / e ci A; t4 ecn di h u 26h a° Yen j, /4 /hest./ C iveg7 .04.1 9 ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * ** * * *** * * * * * * ** * * * * * * * * ** * * * ** Submittal Fee $ Permit Fee $ /SD Gv CCF $ 0.(0.0 co/cc $ Notary $ Training/Education Fee $ 0'90 Technology Fee $ 0 Scanning $ J)/ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 1547 . (CO 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 b ' ding erm t ` (an Is#Altgd l ue� s cgO ttg $2500, the applicant must promise in good faith that a copy of the notice of commenk t and tf ons+t�i hen 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 afier 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. f Signature OL4 -4.d 4.64-1 Signature who is personall NOTARY PUB APPROVED BY The foregoing ms went was acknowledged before me this day of 2� d, 20 / 6, by /U141k1 D i /iN�1z Sign: Print: G rLb4 S4r'e-r (Revised 07 /10 /07)(Revised 06/10/2009) own to me)or who has produced /iks identification who did take an ", "i , 4 ©ILDASUAREZ MY COMMISSION # DD 787664 EXPIRES: June 24, 2012 A 1111; o4` Bonded Mini N tay Pubs undewrners My Commission Expires: c — 24- g 01 2 Engineer Contractor The foregoing instrument was acknowledged before me this 2/ I day of 4)4A.0.. 'L , 2010 , by e�Phil ii1 e who is personalliknown to me r who has produced as ide My Commission Expires: 6-.24 ZP/ . Plans Examiner Zoning Clerk checked 9/09/10 Miami Shores Village Building Department Permits Section Miami Shores, Fla. Dear Sirs: ,irp.-e,51 rio A. Bolivar President Construction Consultants, Inc. � - S L1 39 0 Tr CONS 1 CONSULTANTS, INC. 15566 S.W. 19TH LANE MIAMI, FLORIDA 33185 Re: Roofing Permit RF 10 -752 As the duly authorized representative of Papa John's, I am hereby requesting cancellation of the above referenced permit. Permit RF 10 -752 was pulled to conduct roof penetration repairs above the Papa John store. The permit was never used because the property owner pulled roofing permit RF10 -1215, and conducted a complete re- roofing of the building which included the area above the Papa John's store. Thanking you in advance for your kind attention to this matter.