RF-11-687 i
Miami Shores Village C� 1�
Building Department ;..� R 2011
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1:0050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: 305 795.2204 Fag: 305 756.8972 °- ........
BUILDING Permit No.A t "
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type(circle) Building lumbing Mechanical Roofing
Owner's Name(Fee Simple Titleholder !�&+�' ol.1 U i �u- ?CPkone# y 7 A
Owner's Address '. P Q 3 5
City_kL&LqL C 5 State Zip 3-a 13 9 -
Tenant/Lessee Name Phone#
Job Address(where the work is being done) I Z G® ME q3
City Miami Shores Village` County: Miami-Dade zip
FOLIO/PARCEL#
Is Building Historically Designated YES NO
Contractor's Company am � CO to(( ���1 1 i Phone# O' � �'� - D-- 6
P Y �
Contractor's Address
City ► State I Zip '5 .5 1 ..� .
Qualifier Name -,k (-- 2) (l) o Y Phone# S -7 °�9, �-
State Certificate or Regis tion No.C.e bC(q 3 b ( Certificate of Competency No.
Architect/Engineer's N e(if applicable) / Phone# ..
Value of Work For this I lermit$30, Square/Linear Footage Of Work:%;ja Tl�
Type of Work: Addition FlAlteration ONew Repair/Replace ❑Demolition
Describe Work: 1°u e _. I
Y
Submittal Fee$ 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 Sta Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made oo tain 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 certifaed 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 inspection will
7
Signature
l7 �'i r_-2�. �,P� Signatur '
Owner or Agent' - Contractor
The fore omg instrument was aGknowledg before me this The for oing instrument was acknowledged before me this J�--
�o-�-� �-
day of. j 20 f,by 7 day of -i 20 d I by
who is personally known to me or who has produced who is personally 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: sign:
Print: Print: ��i�► �- L e
My Commission Expires: j ,IC SM� � n My Commission Expires: Cxtherine A..
cathe
APPLICATION APPROVED BY: t ��� Plans Examiner
Engineer
Zoning
(Revised 02/08/06)
Mary Barbara Ivie
' UN Northeast 93rd Street
'I J Miami Shores,FL 33138
�u T305-758-4023
January 15,2014
Viand Shox."Viillage
Building and Zoning Department
1050 NE 2nd Avenue
Miami Shores,FL 33138
To Whom it may concern:
We wish to cancel PermiMM11.687 for a new roof
We intend to open a new permit in the future,
Sincerely yours,
Mary Barbara Ivie
0
Harvey Glee Ivie`�a=t`�-Y
/I
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tEa ..-j�z+irve�Gfeh Zvi
Mary BmfiaraIvie
1268 NE 93rd St 44 -R,.333.
Miami Shores,FL 33138-2941
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