DS-13-280poffro
DING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
PERMIT APPLICATION
Permit Type:
JOB ADDRESS:
BUILDING
10 '�;
1 ';r e3
Ft
r
Permit No. 12Iv
Master Permit No.
ROOFING
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: \e - 32.CR® ® ®`?> -0020
Is the Building Historically Designated: Yes NO W11 Flood Zone:
OWNER: Name (Fee Simple
Address: -50 PAQ. (
f0
City: Tup'm a Q�--' State: Zip:
Tenant/Lessee Name: Phone#: -L?
Email: t�APadf I%-tt6CO_ "V�> �nfVub�C� . rA ,
It CONTRACTOR: Company Name:
Address:
City: State:
Qualifier Name:
State Certification or Registration#:
Contact Phone#: Email Address:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
'n 17 SZ
� Square/Linear Footage of Work:
Value of Work for this Permit: $ • o
Type of Work: ❑Addition ❑Alteration ❑New lkepair/Replace ❑Demolition
Description of Work: - x iS
Color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
i
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
I
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 buildi ith an estimated value exceeding $2500, the applicant must
promise in good faith that a coy of the notice of commend5�, construction lien law brochure will be delivered to the person
whose property is subject to a achment. Also, a certified he recorded notice of commencement must be posted at the job site
for the first inspection whic occurs seven (7) days>a*,r building permit is issued. In the absence of such posted notice, the
inspection will not be appro d and a rei�aspection fee will l�� charged
Signature,
`Owner or Agent
The for mg instrument was ackno edgdtfo�V this i
dayof ,200,by VXT,
who is personal to me or who has produced
As identification and who did take an oath.
NOT.
Sign:
Print:
My Commission Expires:
5tata OT
Notary PuGlic .can 23.2015
c My comm. rAl— ...
commission # EE 128810
Quo; Assn
Bonded Through National Notary
Signature.
Contractor
The foregoing instrument was acknowledged before me this
day of .20 _, by ,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
'My Commission Expires:
APPROVED BY Plans Examiner /honing
Structural Review
(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Clerk
Miami September 16 2014
Re: Permit DS 13-280
Miami Shores Village
Building Department
To Whom It May Concern:
Please be advised that I will like to close the above permit. This is because at the
moment the pool company is working on the construction of pool.
Thank you
el Navarro