RC-11-1519t
it cvia
Miami Shores Village
g
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
BUILDING
PERMIT APPLICATION
FBC 20 o7
Permit Type: BUILDING ROOFING
AUa 1 e eon
BY• --
Permit No. 1 51 9
Master Permit No.
OWNER: Name (Fee Simple Titleholder): Jai-AA-WA E7c44 [Vs.. Phone #: b05-(007-51 51 10
Address: i,.t e 1 st+1 "E"T
City: 'l ti64-11 Sfii0le••E'S State: 4.-0I? -% 64-
Tenant/Lessee Name: (.4/4.
Email: .J o t4 Es ®N t TA. Q L . CD t'1
zip: 33 l 3 t'
Phone#:
JOB ADDRESS: 5 ‘ O $€ 95+1+ StIg -e-VT
City: Miami Shores County: Miami Dad Zip: 531546
Folio/Parcel #: i 1 ' 3 2.0 — p 14 - O b Z✓ O
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name: OW(tC 4
Address:
City:
Flood Zone: lig
Phone #:
State: Zip:
Qualifier Name: Phone #:
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: 175 4007 - 5'7 1 C' Email Address: J 014 $oN I Teo C! G1 L • GQi�t
DESIGNER: Architect/Engineer: Loom % 6 ete.ittst E E -i N!t 1 t4 G. Phone #: 194 -(Dcil ' e)617
Value of Work for this Permit: $ 'f� �, 5j' 00 gm/ Square/Linear Footage of Work: 85 54 • ice' •
Type of Work: Addition eUAlteration ONew ORepair/Replace ODemolition
Description of Work: NEW €1A'mr f ooth 1 (.ESL ex %ST1 N6(
***************************************Fees******** * * * m ** *** * * * * ** *x:x:****** *** ***
Submittal Fee $ 5 Permit Fee $ CO/CC $
l `
Scanning Fee $ Radon Fee $Pik$ Bond $
Notary $ Training/Eddueation -Fge,$ ' ' Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable) NAA
Bonding Company's Address
City
State MEM Zip
Mortgage Lender's Name (if applicable) bi4r1414 COP i t C.i
Mortgage Lender's Address F. 0. coo 7 0
City S State DC
Zip 7 S Z CmS
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, BOTLRRS, 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 Signature
0
The f. going ins. ,.sent was
dayo 0!L ,b
gent Contractor
knowledged befo me this 1 g The foregoing instrument was acknowledged before me this
d ! r _' , day of , 20 by
who is personally known to me or who has produced
did take an oath. as identification and who did take an oath.
who is pers .'. ally mown t r who has produced
•;
'� Commission Expires: .-;q + �;,. � � P O
M
.+= MY COMMISSION S DD 896284
el-11 -
Bonded Tin Wary Public Una EXPIRES: July 11, 2013 * * * * * * * *kkxkkkk** *** *kkx *** ** *kxxkk *kkk **
k*** * * * * * * *xk *** **k**** **� **** k*** *kk *kkkxkkk **** ** *** **
Plans Examiner /7,
Zoning
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY
V% VP
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Structural Review Clerk
V
SEP 2 8 2U11
September 27, 2011
Miami Shores Village
10050 N.E. 2"d Avenue
Miami Shores, FL 33138
Building Department
Re: Permit Number RC -8 -11 -1519
Site Address: 510 NE 95th Street, Miami Shores, FL
To Whom It May Concem:
I would like to cancel that above referenced permit submitted on August 19, 2011. The permit was not
issued by Miami Shores Village as plan review was currently underway. Prior to issuing the permit, I
would like to cancel the open permit / plan review as I am not moving forward with the project.
As reviewed this morning with a representative from the Village, I would like to have the drawing sets
retumed to my attention.
If you require any additional information, please contact me at the number below.
Thank you
Jon Bonita
305 - 960 -7541