RC-11-06094i�11 9i%n It
BUILDING
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Miami Shores Village X11
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Building Department PR 0 6 2011 �y
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: ••••••••••••••• ° °' ° ° "°
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. /
PERMIT APPLICATION Master Permit N
FBC 20
Permit Type: BUILDING
OWNER: Name (Fee Simple Titleholder): Q& t4J %U FR A G Ar4 Phone #: S ® ea
Address: 2 3 (0 g E, q t n- ST.
City: bAIAMI RIA0RP_% w State: Fl- Zip: SS Ias - 3128
TenanVLessee Name: Phone #:
Email:
JOB ADDRESS: 2 3 (121 KIE ()I tTi ST
City: Miami Shores County: Miami Dade Zip: 331315 — 3 d 2S
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
Address:
City: State:
NO e/ Flood Zone: 140
Qualifier Name: Phone #:
State Certification or Registration #:
Contact Phone #: Email
DESIGNER. Architect/Engineer: SELF
Certificate of Competency #:
Value of Work for this Permit: $ AM • ®® Square/Linear Footage of Work:
Type of Work: OAddress OAlteration Ql�ew ORepair/Replace ODemolition
Description of Work: Am> -ryy® IbA5e ClbA?zlt4P_T:s 1 SE.GT1 00 ®f� w4269°
c t-ITEtL sanAs yaeo! Astry Of 9 L[#1 R. eur
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by.
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Notary
Radon Fee $
DBPR $ Bond $
Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
state
zip
zip.
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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 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. Asa condition to the issuance of a building permit with a# estimated value exceeding $2500, .the applicant must
promise in good faith that a copy of the notice of commencement and constrai t� an: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
Owner or Agent Contractor
The fbregoin6 instrument was a owledg bef me this The foregoing instrument was acknowledged before me this
day of , 20 L by ' uY f . 20 by
who is personally known to me or who has prod s personally known to me or who has produced
As identification and who 1 e an oath. as identification and who did take an oath.
NOTAR PUBLIC:
Sign:v 1
Print: !' .111,
My Commission Expires:
APPROVED BY %'�' Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10)
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
Zoning
Clerk
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Miami Shores Village Building Department
10050 NE 2"d Ave.
Miami Shores, FL
33138 -2382
Re: Kitchen Permit at 236 NE 91 at St.
Dear Sir or Ma'am:
I am writing to request a withdrawal for a permit application.
Daniel Fruciano
236 NE 91st St.
Miami Shores, FL
33138 -3128
27 septembe , 2011 RECEIVED
SSP 2 8 2011
IBY:
(2,C. I t -- Q-)09
After seeking the initial permit for a kitchen renovation, which was denied, I made several
attempts to seek assistance from contractors who could do the work for me. I was unable to
obtain any viable option. As a result or this and a changing economic situation, I have elected not
to proceed with the work at this time.
If any additional information is required, please feel free to contact me.
DLFciano
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