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FW-11-2375Miami 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING n l OWNER: Name (Fee Simple Titleholder): /C/ 4" i'3 �0z `v Ph e# /`� `3 Address: * �C� Rol DE 2 7 2011 �, B ': Master Permit No. City: W 71/ State: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: g % /V&-- r/ /< fGe , City: Miami Shores County: Miami Dade Zip: 3._, Folio/Parcel #: 4 — -;1:)?,-106 – 003 s 00527 ZiA: 03 439 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ,e nn(2� /7 /©('�� 2' Phone #: Address: nO ° C ) V01 Yy City: 011I2%i te: Foe Qualifier Name: ,e�Cti State Certification or Reg'' - t , C 05 y,3cQ Certificate of Competency #: t22Ct /1 /V@) /92 al. Gr7/n Zip: ,7,3.3 / -7� /gyp Phone #: Jos - Contact Phone#: 4 79 f °/ ,J G Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ J j)j) . ( Squar inear Footage of Worms Type of Work: °Addition °Alteration ONew °Repair/Replace Description of World; 7X S 1 / GL id? k 7 virte ,90g ❑Demoliztion eacit- 1 .7 *****+************ *+ x**• x*+ x+x+x+x******* * * **Feesm***** Submittal Fee $ Permit Fee $ dad Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ ci✓l$ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ VAD Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address " e Zip • 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, BOIT.RRS, HEATERS, TANKS and AIR CONDMONERS, 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 att chment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which urs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a rove and a reinpection fee will be charged. Signature Owner or Agent The fore oing instrument was acknowledged before me this 46 day of ea a, , 20 /1, by �l se /Wcr alc who is ersonaknown to me or who has produced.`' d Who did takean oath. Sign: Print: My Commission Expires: APPROVED BY ,y' • fit JULIA AIAomfA • (407) 398 -0183 MYt � . L COMMISSION r � � � � � � #y � yD D 913 / y8 0 4 FlorldalloterySerwlca.com Plans xammei Contractor /� �mennt was acknow;dged before me thisav l -ee 6 1, 20 -11, by o is personally known to me or who has produced 1 /L� 0 ' s ehtification and who did tak an . th. Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) NOTARY Sign: Print: My Commission Expires: yy�C�i try JULIA AMO OVA "° MyY� COMMISSION .y #RyD],,,CI913804 153 F da rvice.com ** mng Clerk 'l 42, C E JUL 0 3 1) 012 MONTANA 13 HOLDINGS III, LLC 407 Lincoln Rd, #2K, Miami Beach, FL 33139 Ph: 786 - 361 -0971, Fax: 786 - 361 -0948 July 3, 2012 Miami Shores Village Building Department 10050 NE 2nd Ave, Miami Shores, FL 33138 Ph: 305- 795 -2204 Fax: 305- 756 -8972 RE: Permit # FW -12 -11 -2375 I, Elise Fable Macaluso, owner of Montana 13 Holdings III, LLC, owner of the property located at 941 NE 91st Terr, Miami Shores, FL 33138, request to close permit # FW -12 -11 -2375 for the Chain Link installation due to the fact that I decided not to install the fence. There was no work performed under this permit. d sworn b foru me, this tary Public County, (Signature) NOTARY PUB My Commission expire •+ea�P o JULIA AMOSOVA 3'• F MY COMMISSION # DD913804 A F, EXPIRES August 04, 2013 (407) 398 -0193 FlorltlallolarySeMce.com « 7 �� Pe, kclo Julia Arnosova Julia @latourdesign.com Design & Development Oft 305 695 9090 Fax 305 695 3886 Cell: 305 781 9734 270 NE 61st Street Miami, FL 33137 www.Iatourdesign.com