FW-12-1976* I " - L+1
BUILDING
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
PERMIT APPLICATION
Permit Type:
JOB ADDRESS:
BUILDING
) 657 1-
OCT 18 2012
FBC 20
Permit No. PW l 2
Master Permit No.
ROOFING
City: Miami Shores County: Miami Dade Zip: 8'
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
k d s+
OWNER: Name (Fee Simple Titleholder):_' f-� Phone#:_
Address: /®��
City: LA (A-00 %' � State: Zip:
Tenant/Lessee Name: Phone#:
Email: w
CONTRACTOR: Company Name:
Address:
city: 1 State: -F-(--
Qualifier Name: Vi GC *�-4'1, t.' Phone#:
State Certification or Registration #: 16, 1�� I C� Certificate of Competency #: _
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ Svc' Square/Linear Footage of Work:
-W k674 3 �
I
Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace - ❑Demolition
Description of Work:
Color thru tile:
Submittal Fee $ i-Q, Permit Fee $ �l� e CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
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
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 PROPER - PROPERA IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH Y ER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE EMENT:'
u
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 inTection which occurs seven (7) days after the building permit i� issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. .
SiunatnrP
Owner or Agent
The foregoing instrument was acknowledged be ore me this
day of, 20 �2 by tYs7i�Yti1G11,(Q <,G{ ;
who is personally known to me or who has produced
NOT
Sign:
Print:
My
As identification and who did take an oath.
PUBLIC: Notary Public State of Florida
± Clarissa Egane
t My Comma DD940681
Expires 11 /1812013
APPROVED BY
11,/ I to (1,6 -�
Contractor
The foregoing instrument was acknowledged before me this
day of , 20�, by V i a L th
who is personally known to me or who has produced
Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06AW2009)(Revised 3/15/09)
Sign: `
Print:.
My Commission
rikNotary Public State of Florid8
. Clarissa E"M
+,� t My Commission DD940681
y'� ExpU®s 11/18/2013
Zoning
Clerk
Arlenis Silvera
From: veronique lestrade -sfara <v.lestrade @mac.com>
Sent: Wednesday, January 22, 201411:30 AM
To: Arlenis Silvera
Hello Arlenis C—w ` 2 ` r
I am asking you to cancel the permit for the Temporary Construction Fence Chainlink. We never did it. �{
�e
Thanks a lot
'f2 C
Veronique Lestrade SfaraI
I