WS-06-1893RECEIVED
FEB 18 2012
BY:
February 13, 2012
To Whom it may Concern:
In 2006 I opened a permit to place hurricane shutters in my house. After doing that the
person who was going to help me with it became unavailable and I never started the
work. I would like to cancel the permit if at all possible. ° ..ta- UJS C1:3 -tr I
Adojfo alez- Garcia
262 N 93 Street
Miami SHores, FL 333138
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit No. INI"Iefis
Master Permit No.
Permit Type (circle):( Building l"� Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) /' £cwia /ei 6t('(,f‘G Phone # JO5 3- a.o6" Oc:j 6�
Owner's Address CCaf 6_oa,, Nle R, yj , 4
City t'aN.� S State FL Zip -S31 e )
Tenant/Lessee Name
Job Address (where the work is being done
City Miami Shores Villa • e
FOLIO / PARCEL #
Is Building Historically Designated YES
County
Miami -Dade
Phone # As 4
tas "A,: FC 33 I3$
Zip J-2JI c�C7
Contractor's Company Name
Contractor's Address
GWkor
NO 04.
Phone #
City State Zip
Qualifier Name Phone #
Certificate of Competency No.
State Certificate or Registration No.
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $ / . 00. f�
Type of Work:
Describe Work:
Phone #
tl ED
LaPork: • -4R 3 14as.
['Alteration
fri
►/New
❑ Repair/Replac - 0 Demolition
Al
* * *, * * ** * * * * * * * * ** * *** * * * * * * * * *** *� * * * * ** Fees************* *** * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ .•-• CCF $ CO /CC'
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
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 welial lations as indicated. I certify that no work or installation has
commenced prior to the issuance of a �"`t
p permit and�that all will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that °a sep permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, __ __ _ _ __ _ BOILERS, CFK TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that a 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 a • a reinspection fee will be charged.
Signature �,,�
The fore
day of
who is pe,
er or Agent
oing instrument was acknowled(ded b fore me this 07/
/I
20 b by i
NOTARY
ally known me or who has produced
As identification and who did
LIC:
oath.
Contractor
e 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: Sign:
Print: Print: /?II71 � SOY. IMUGtAS GRA#81"4 r t
l
-t• EXPIRES: Februarys 20b 1 M
agze Bonded Den Notary Public Underwriters
******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
* * *
7
Commission Expires:
F
7
ac.
Plans Examiner
Engineer
Zoning