DS-11-171 U Lk 1 Miami Shores Village
ABuilding Department Y:
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 No. I�
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: BUILDING
OWNER:Name-(Fee Simple Titleholder): A/L�ttt— W Q (^Wo n Ph.,e4: 1?1�7 1/
( V2-1
Address: hh% Vw III Slfr_c _. _
City: zt CR ''"
'. , State: Zip: 33 'jV
Tenant/Lessee Name:: y Phone#:
Email: G_YLGI-e K's Wex-o'S 041(!�d 1'2 0�W O-0 LD M
JOB ADDRESS: .;z 1 A101 q1 S4 Y4_,t�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone: /yo
GL41
CONTRACTOR: Company Name: M4IXW BeAG4 CpMf.(1)fa" hone#: SM V36061 a
Address: OL455 'PWJtJSNwA+.JIA AVIE MlkM\'S� e,1-r fie. 3
City: WA"1 State: Zip:_3$ (3G
Qualifier Name: M1 WQkD r FD12CYLO Phone#: 78653q tig Lz.
State Certification or Registration#: fate of Competency#:
Contact Phone#: 15 Email Address: Coke—,
DESIGNER: Architect/Engineer: ji Phone#: tJ) A
Value of Work for this Permit: OG Square/Linear Foota rk: zlft;
Type of Work: ❑Address ❑Alteration )(New ❑Repair/Replace ❑Demolition
Description of Work: I 0ST74t_ Q6-.4j _DLjV_ e_7rpj? j621WcyAj" e, SWOLLE
—Tb "1(L91t!j: V 11>Le ( a tJ GA5i — j o— '7'7 36
THROUGH ROOF TILE IS REQUIRED acknowledged by:
COLOR
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YcY 1*1:F:F4*1*1.**:F:F:F-.111,:F**:1,11
Submittal Fee$ 50- Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
Bonding;ompany's Name(if applicable)
Bonding Company's Address
City State Zip
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. 1 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 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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will n t be approved and a reinspection fee will be charged.
Signature Signatur -►
Owner gent ContrActor
The foregoing instrument was acknowledged before me this r The foregoing instru acknowledged before me this
day of 20 11 ,by Arlt' e ��n SOO day of 2 M O-0" FO Yt*6,
who is personally known to me or who has produced W(say,111who is personally known to o has produced Inc QQc.1
D W n As identification n w as ident <e an oath.
CAwA ?ooR�"oa4^ Notary public State of Florida
NOTARY PUBLIC: NOTARY PUBLI Y f Anne K Swanson
up COMM.bpm I kv 14.Nit F`
,� a My Commission DD669396
C 0 Do NOW Ex ires 05/01/2011
Sign:_4&-oi11M Sign
Print: &4vbn k Mn. Print: }t V�VI� VYGL�I'l S
My Commission Expires: My Commission Expires:
14, Z01Z
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)(rev6/4/10)
low
sars~wo low
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Anne Swanson
249 NW 91 Street
Miami Shores, FL 33150
305.764.8842
July 7, 2015
Miami Shores Village Building Department
10050 NW 2nd Avenue
Miami Shores, FL 33138
Dear Miami Shores Village Building Department:
Please close out the permit I applied for to install a driveway in the village owned swale in front of my home.
I had an issue with the contractor and have not found a replacement.
Sincerely,
Anne Swanson