PL-06-1621\?1:51X)
iami Shores Villa ,ge
wilding Department
0 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: 3 ) 5.2204 Fax: (305) 756.8972
ins
BUILDING N\'''
PERMIT APPLICATION
FBC 2004
B
OTERWM
UN 1 2006
Permit No.
P °0L Z0
aster Permit No.
Permit Type (circle): I Building Electrical
Owner's Name (Fee Simple Titleholder) ae c r l t a.
Amu-- Mechanical
E PO A - Phone #
Roofing
3oS =33o?a 715'
Owner's Address - T> NE la
City /1t C State i= L Zip /5 8 4
Tenant/Lessee Name
Phone #
Job Address (where the work is being done) ,c) NC /0 /
City Miami Shores Village County Miami -Dade Zip
? FOLIO / PARCEL # 111 — 3), a -(43- 3
Is Building Historically Designated YES NO A
Contractor's Company Name
Contractor's Address • I ti L, (
City V1 ("
Qualifier Name %% -° d
1Ve L a v lPS Phone # 75o yr9, - 94, 7 9
State Zip ? J Ud ( q r ar
Phone %% Gf 1 76 7
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
Type of Work: ['Addition
Describe Work:
Phone #
['Alteration
Square / Linear Footage Of Work: 6 , )
['New
Repair/Replace
❑ Demolition
* * * ** * * * * * * * * *,� ,� & ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * ** *** **
i
Permit Fee $ /// C/
.2—C)
Submittal Fee $
Notary $ �A
Scanning $ CC
Training/Education Fee $
Radon $
CCF $ C) CO /CC
Technology Fee $ °
DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Total Fee Nov{ Due $ i 2 . 30
See Reverse side -*
Structural Review. $
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 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
Owner or Agent
The foregoing instrument was acknowledged before me this 113 The fore .
day of caf i , 20 `' (f by (2 ,r; d 6ite'r" °;r i , day
Contractor
oing instrument was acknowledged before me this 5
, 20OCcby ��G d t s
who is personally known to me or who has produced :%/ _. " t L? /a'.� 1 J t' - who is personally known to me or who has produced
(44r-;S " As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
My Commission Expires:
L
as identification and who did take an oath.
Arikk
MONICA USSETH DIAZ
1 11 Y. •1:PJ':K "4
NOTARY PUBLIC;
j, ;�4f , uzUC. STATE OF FLORIDA
.„ Hernan
' 17JImiN.Q�
N \91
er 4
r********* *** ** *** * *** ** * * * *** ** * * * ** ** *, ***********; ��q/*********************** * * * * ** * *** ** * * * * *** ** * * * * * * * * **
APPLICATION APPROVED BY:
(Revised 02/08/06)
a() Plans Examiner
Engineer
Zoning
October 23, 2008
To Whom it May Concern
I received a call from Miami Shores Building department that stated that I owe permit fees for repair of my
sprinkler last year.
The facts are that the sprinklers were simply repairs and I was told by the head of the building department (and he
wrote it out on our permit application) that I did not need to pay permit fees.
I hop this resolves the matter and closes that file. If necessary I will dig up the document that he gave me for my
cousin to allow him tondo the repairs to the sprinklers.
J(`
Thank you
Cecilia E. Holloman
90 NE 101 St
Miami Shores, Fl 33138
_ Ms. Ciadiallollzrzow
90 NE 101st St
Miami She, F1,33138-2319
I'm a supporter
MIAMI FL 331
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