DS-13-1586Miami 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
Permit Type:
JOB ADDRESS: jt ,, j 9 o -1 4,- - .
pYBL
1 6
JUL 28B
By-__ ----------
FBC 20
Permit No. PSI 3 -15 &,0
Master Permit No. l
ROOFING
City: Miami shores County: Miami Dade lip;a
Folio/Parcel#: _0 e a 5 4), Lf �O
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder):
Address
City: State:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: W �� - � �� J r,,r (, Phone#: 7 L cP-5%
Address: Z J. /7 YOC- HiN-Co, 14
City: �4 A.(-r=A State• gip; i
Qualifier Name: V I C- eo6,(_ Phone#: �i �' � B -P-9
State Certification or Registration Certificate of Competency #..
Contact Phone#• -°� �� a Email Address: _ `�'� ► t"" ,��� °'� ` 0.1�_. r-�.�
DESIGNER: Architect/Enginew. Phone#:
Value of Work for this Permit: $ n J Square/Linear Footage of Work:
Type of Work: ClAddition OAlteration 13N 4 URpair/Replace ODemolition
Description of Work: _P" (/JZ� p , 7 ®C 0
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Stractund 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
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."
Notice to Applicant. As a condition to the issuance of a building permit with an estimated v
promise in good faith that a copy of the notice of commencement and construction lien law
whose property is subject to attachment. Also, a certified copy of the recorded notice of con
for the first inspection which occurs seven (7) days after the building permit is issue. .
inspection will not be approved and a reinspection fee will be charged.
Signature 1�
� Signature_
Owner or 41e nt
The foregoin instrument was acknowledged before me this 2
day of L�Z . 20 13 byi��UL�✓J< < (✓
who is personally known to me or who has produced tom' l y
ding $2500, the applicant must
will be delivered to the person
�t must be posted at the job site
nce of such posted notice, the
The foregoing instrument was acknowledged before me this
day of °0 , 20 L?�, by
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.
NOTARM%�
Sign:
Print: OLMASTELLAVMEROS
My Commission Expires: * * EXPIRESS'':: May 6, 2015
A.".0-001
Wed Thou Budget No" ServiNS
APPROVED BY
My Commission Expires:
Structural Review Clerk
(Revised 3=2012)(Revisai 07 /10107)(Revised 06110DM)(Revised 9n 5/o9)
January 21, 2014
Miami Shores
Building Department
10050 NE 2nd Ave
Miami Shores, FL 33138
Re: 118 NW 104th Street
Miami Shores, FL 33150 -1240
Permit #: DS -7 -13 -1586
Permit Type: Driveways /Sidewalks /Slabs
To Whom It May Concern:
This is to request an extension on the permit referenced above, that will soon expire.
The reason for this request is that we have not completed the interior renovations (i
needed to complete the driveway work. X'
Thank you for your immediate attention to this matter.
If you have any questions or concerns, please do not hesitate to contact me.
Sincerely,
Melquicedec 0. Viveros
General Contractor
License # CGC 1516249
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