DGT-11-6520A`';L0Ij1 -L.-ri
` Miami Shores Village
Building Department
90050 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
OWNER: Name (Fee Simple ° `fi
Titleholder): t
Address: Y q 1 1 C— I (e) I .. 0 0
City: I I IALk_k)
Tenant/Lessee Name:
Email: (�C—Plc�
JOB ADDRESS:
City: r
Folio/Parcel #:
Is the Building Historically Designated: Yes
l�
APR 13 2011
Permit No.
Master Permit No.
(-?j
State Zip:
PRO
Miami Dade Zip:
Zone:
CONTRACTOR: Compapy Name: �A �i `e Phone #:
Address:
City: State: Zip:
Qualifier Name: Phone #:
State Certification or Registration #: ' Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer:> Thane#: _
�T-
Value of Work for this Permit: Square/Linear Footage of Work: 4
Type of Work: ❑Additio(n� ❑ terra�tion O ❑N`ew ❑Repair/Replace ❑Demolition
Description of Work: ) e � o2 U- _ ke)o U �I 1 t L—VA.a 1J
Submittal Fee $50• 0�3 Permit Fee $ CCF $ CO /CC $
L
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
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
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.....
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."
i
Notice to Applicant: As a condition to the issuance of a building pen
�it�9w4th 'an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement at* construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copyof ihe'recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after t k,Aiilddrig permit is issued. In the absence of such posted notice, the
inspection will not be approved and a re' ction fee will bec�ht►`ged.
Signature Signature
r or A
gedt 2 Contractor
The foregoing instrument was acknowledged before me this 1.3
day of 1t I -20 by �L�51 (� CIAS 06k �.�.
who is personally known to me or h y>�ed
is eke an oath.
NOTARY PUB I U0 Ss14Y#jo f�
Sign:
The foregoing instrument was acknowledged before me this
day of .20 _, by ,
who is personally known to in duced
n�h�dF�who did take an oath.
NOTARY C:
Sign:
Print ''., °pit ;. /dX� ':.?� ..�`� Print:
' /
My Commission Expires: / /i / ; / '/IIS�iva\� \\\\\\` My Commission Expires:
Y � :=x =�n� :. ������=x��
APPROVED BY Plans Examiner // Zoning
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
156
To Whom it May Concern, " w-1)%fY #- 067 // f�d
I, Alysia Casebeer own the property at 319 NE 101 Street, Miami Shores.
I began the process of trying to build a Pergola on the property. Once we found out that the structure
had to be positioned at least 10 feet from all property lines, we chose to not put the structure up.
There is no Pergola on the property at this time.
We are currently working up a contract to sell the house and I need to have this permits closed, or
cleared as soon as possible.
Thank you for your assistance.
Alysia Casebeer
786 - 390 -3510 cell
o �.�1
K
i
Alysia cLvbwr
,4114-.,,. g. dr y
319 NE 101st St 41
Miami Shores FL 33138 r
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