DS-13-1862Miami Shores Village
Building Department
1000 N.E'bW Avenue, WMW MMai3139
Tel: (305) 7952204 Fax:
(305) 762.4949
BUILDING
PERMIT APPLICATION
Permit T�pe: �D
JOB ADDRESS:
AUG 14- 2013
FBC 20
Permit No. :Q�l 3 — ff
MWAM Permit
chr. - wa $MOM --county. MIAMI Dade
Folioftcew. —LL-24 5 G0 110 a0 n
R the BvMft Mdo*dy Des1patak Yes NO
OWNER: Nam (Fee Simple
AdA.- * I L I — � -::
ROOFING
Zone:
TcnanWAm Name:
Email:
�3
CONTRACTOR: Company Name: -106ra�a A e-1 Phnnpjl• C?, 3v
'2 1 q� (4 71
Address: � S VJ -3 -z e Y I I
city. --Pi-" I 9AYU4-g- - -State: •
-33 0
Qualifier Name: •
Q4 X
Mwue#. 2-
State Certification or Registration #. -9 -Yj�
—0-cgc - t2 tc:�--certificaft of Competency #.. —
ContactPhonek. � f ?RA Email Address: M I
--
DM6140h Arcb wtectfEngine L/
Value of Work for this PamfL- $ -/ SquradJnw F80t4P of Work:
TYPeofWork: DAMdon 171A"O—n = ONew
Of Work
V%
MUIRW Fee Permit Fee $ CCF CO/cc $
Saftft Fee $ Radon Fee $
Notary TMWIR9WAlucadon. Fee $ DBPR $ —Bond
n.161.w.* — Teebooloff Fee $
Stractnral Review $
TOTAL FU 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
0
Application is hereby made to obtain a permit to do thewiu'ons as indicated. I certify that no work or installation has
commenced prior to the issuance of a permi fly v ,� performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand a; ! t must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, , 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 an
applicable laws regulating construction and zoning.
"WARNING . TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
MPROVEMENTS 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 $23to, 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 cerk ied 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
Signawre �l L-
Owner cr Agent
The foregoomg�mWument was acknowledged me
day of ; 4 20,, -" "`�"
w s �' wn to me or who has j�.
As identification and who did take an oath.
NOTARY P1IBLIC: Z
APPROVED BY -'— i Plans Examiner'.
Contractor
foreg in ent was acknowledged before we
tbis'� G
of l _ < 2 %by
wn to me or who has:produced
Structural Review
(Revised 3/12=12)0taWsed 07n W?)(RevhW (w1o/1A09)(Revlsed 3/15/9)
as identification and who did take an oath.
NOTARY PUBLIC:
My Commission -=
�; C;K4KD'( POIK DU JOUR
'; _ MY COMMISSION D l 2 113 '
Zoning
or
FGCC PROPERTY INVESTMENT INC
MARIE G. PIERRE
181 FULTON ST
MEDFORD, MA 02155
05/22/2014
RE: RE: REQUEST FOR CANCELLATION OF PERMIT REQUEST
38 NW 109 STREET MIAMI SHORES FLORIDA
To Whom It May Concern:
�Ao
04
I, Marie G. Pierre, hereby wish to cancel the open permit for the driveway of my
property located at 38 NW 109 Street Miami Shores Florida. I was going to repave my
driveway on my own will but due to unforeseen circumstances; I have changed my mind.
Please cancel this driveway construction permit request as soon as possible.
For more information please call 781- 249 -4114.
Thank you!
c
FGCC Property Investment Inc.
CANCELLED