RC-10-651Miami 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) 762.4969
t+1C Permit No.
ATION Master Permit No.
ermit Type:
Owner's Name (Fee Simple Titleholder)
Owner's Address 0 l0 Pj N V\l
City 4 c rt , It'-‘011grS State
Tenant/Lessee Name
ba\ltd d poc 4e
°( 5 Sir-rec.-1-
FL.
Phone #
(3 OS) -758 ° c?) e'tg
Zip
Email home co ore earl -( clot. c..e. r.r
Job Address (where the wc}rk is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # a 0° 3 1 0 1 — 0 Q1-1 4 O a 1 0
Is Building Historically Designated YES NO X
331 5®
Phone #
1(05 tv J 0i5 SA-Nre c4
Contractor's Company Name
o
Contractor's Address
City State
Qualifier Name
Phone #
33t50
Flood Zone
Phone #
Certificate or Registration No. Certificate of Competency No.
'Contact Phone
E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $
Type of Work: ElAddition
Describe Work:
300.00
❑Alteratio
Square / Linear Footage Of Work:
❑New ❑ Repair/Replace ❑ Demolition
Sfor49 c ` ci
(
Q
� * �: �j*�* *�: �** i�**• x*�r****** *:r *•x +•x*,��x�:**,�* Fees: �, �, �* ** �r* *** �r* �r: �* *• x*** ***** ***�x•xx�:•x:�:ra�***+*:r*
kutfirrutt l Fee $ �JI..J'"UO
Permit Fee $
,/ OU CCF $ (00 CO /CC $
Notary $ Training/Education Fee $ Ot20
Scanning $ t-Q • CO Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Technology Fee $ 0 k7
Structural Review. $ Total Fee Now Due $
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 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
Owor Agent
The foregoing instrument was acknowledged before me this . °I
day of r r0 , 20 9L., by too.na
who i ersonally know to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissi
(407)99B -ow =
c' �® ao /a,
** * * * * * * * * * * * * * * * * * * *:r * * * * * * * * ** *********�************************************* ** *** *** * * * * * * * * * * ** **** ** * ***
APPROVED BY - 4l� Plans Examiner l / 1 t(O Zoning
;,nary 20, 2012
--11d:IN,..,;T.TvGcrvicegorn
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
Clerk checked
Jul 0811 03:40p Home Care Enterprises Inc
July 01, 2011.
David Aponte
165 NW 95 St.
Miami Shores, Fl. 33150
Ref: Permit # 5 -11 -8614
To Whom It May Concern,
3056874161 p.2
JUL 1 1 2011
Bpi:
C 1 O-'(nS )
I am the home owner for the property at 165 NW 95th St. I requested a
permit to have a shed on the back of the home. The purpose of this letter is to
request to cancel the permit that I requested; I won't be able to do anything 2 -3
months from now. Nothing has been done, and for the moment we are stopping
any future projects planned.
Sincerely,
David Aponte