PW-12-1630ECiF*I_E9 .5
June 24, 2013
Miami Shores Village
Permit Department
10050 NE 2nd Avenue
Miami Shores, Fl. 33138
Permit No.: PW -8 -12 -1630
Address: 9537 NE 2nd Avenue
Miami Shores, Fl 33138
To Whom It May Concern:
This is to certify that the owner of the above referenced address, DVS LLC, has cancelled the
request for new gas service lines. As a representative of TECO Peoples Gas, the permit holder
of the above referenced permit I, Jesus Vega Jr., request Miami Shores village to cancel the
aforementioned permit.
Jesus Vega
Local Operations Manager
N Miami Division
State of Florida
County of Miami -Dade
On June 24, 2013, before me, Nora Arias Loftis, personally appeared, Jesus Vega*. personally
known to me and acknowledged to me that he executed the same in his authorized capacity and
that by his signature 011 the instrument the entity upon behalf of which the person acted,
executed the ins
4' ..-
ra Arias Lo - is
PEOPLES GAS
15779 West Dixie Hwy
NORTH MIAMI BEACH, FL 33162
HTTP: /NVVVW.TECOENERGY. COM
AN EQUAL OPPORTUNITY COMPANY
305 957 -3857
FAX 305 -957 -3804
Miami 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: PAINT
OWNER: Name (Fee Simple Titleholder):
Address: 10 f{ M t/• E• 44 ilk
City: MI Pt StIoR e 5
Tenant/Lessee Name:
Imamw9
BY:
Permit No.T I 1 1 A/9
Master Permit No.
Ig o N Nkr3c R.P;o e. Q Phone #: - rig g 343
State: 1-4:L. A Zip: 5931 3
Phone #:
Email: DT LA . Ao' • (`,,p tM
JOB ADDRESS: SA Mt (!S Abo V C,
City: Miami Shores County: Miami Dade
Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO V' Flood Zone:
CONTRACTOR: Company Name: ( W 4c 2 ^ Phone #:
Address:
City: State: /� Zip:
Qualifier Name: %/)
Phone #:
State Certification or Registration #: Certificate of Competency #:
Email Address:
Value of Work for this Permit: $ 50 0 - Square/Linear Footage of Work:
Description of Work: ilia S C, eAt A+
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
"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."
Contact Phone #:
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 an inspection fee will be charged.
**** * * * * * * * * * * * * *** * * * ** **** ** x *** *** ** Fees**************** *************:x******** ** * **
Permit Fee $ CCF $ Notary $ Training/Education Fee $
Technology Fee $ Double Fee $ TOTAL FEE NOW DUE $
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
DIRECTIONS: Please circle corresponding number to appropriate color sample.
Walls:
Fascia: 1
Drip edge: 1
Soffit: 1
Roof: 1 2 3
Flower Bins: 1
Shutters: 1 2 3 4
Awnings: 1 2 3 4
Chimney: 1 2 3 4
Doors & Jambs:1 2 3 4
Garage Doors: 2 3
Railings: 1 2 3
3
Fences:
All Brick:
Stucco Bands: 1 2 3 4
Other Stucco
Feature: 1 2 3 4
Accessory Bldg: 1 2 3 4
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.
Signature:
Signature:
Owner or Agent l Contractor
The foregoing instrument was ackn 12. wledged before me this The foregoing instrument was acknowledged before me this
day of 1 , 20 1 1 , by d 11n1 e M tt iro c P day of , 20 _, by
who i
ersonally known to me
who has produced who is personall}) known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
'`
*rri, EXPIRES: OCT. 05, 2014
inGsFiao WWW.AARONNOTARCcom
David E. Nolan
Sign:
Print:
My Commission Expires:
*+x**+x+x: *** ass:. x*+ x** ********x: m*:xa:*******:x*s: ****** ** x ********+x:x**** ***** r., ** t *** *, a��x*** ** *�x *�:�x�x�x�x�x *�:+xx�:x ****
APPROVED BY: � • 1.7 Code Official
Preservation Board