MC-14-1566 Miami Shores Village Jug
Building Department 13Y: °�4
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 200®
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING EdMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:�—M E Cjk S1 f4E e -
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): T.efe., Me-L, \cA Ve-AieVA Phone#: Q� 1
Address: 1 t-1 N\ 9 ( S 1f4 C.*-
City: Nk %La res State:Et'z-c-v Zip:
Tenant/Lessee Name: Phone#:
Email: KNe-Ai-,ck sc,Ac 12 �oL,s®.
® pp
CONTRACTOR:Company Name: 1` (1z JC-)e •Phone#: -3CaS p 1 la
Address: Lcv w` ��"��- C' T• k*b -
City: "1 CAvyl I State: Zip: 3 3 1 7 2-
Qualifier Name: ?,1 C-',1�-.® erc--n ac-;%► Phone#: 7-c'!S- Z i to- -7 7('LP
State Certification or Registration MI (>4 3 0 `7 —7 J Certificate of Competency M C AC,® 57 1-7S
DESIGNER:Architect/Engineer: Phone#:
Address: {� City: State: Zip:
Value of Work for this Permit:$� 01D Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: "LU e
Specify color of color thru tile: "�
Submittal Fee$ ermit Fee$ ®`3 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
' w
Bonding Company'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. 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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS, HEATERS,TANKS,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 not be approved and a reinspection fee will be charged.
Signature e nature
OWNER or AGENT ONTRACTOR
The foregoing instrument w s acknowledged beforhis The fore oing instrument was ack owledged before me this
-day of �� 20_by day of 20 by
-teaZ� p C l Y? ,who is®person known to P+vho is pers ally known to
me or who has produced ���t c �/ . as me or who has produced OfVe as
identification and who id take an oath. identification and who did take an oath.
NOTARY PUBLIC: C NOTARY PUB VC: o
Sign: Sign:
Print: v C�i i° (�+✓�f'7 C Print.
Seal: Seal:
J�lPRY FV0�4, RICARDO J.MARENCO E
_ ow
Notary Public State of Florida ;OtiPNV P�B��,, Larb
O J.MARENCO E
" My Comm.Expires Jan 2,2016 =a:�:°'_ Nic-State of Florida
Commission#EE 156540 ° " "�= MExpires Jan 2,2016
iN o a Qr*+k* �k�k'EO �`0nI' `b"
APPROVED BY - �� I Ilans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
._A
Oct 0lnOCT (/� 9 i
Oct., 11n
� � � 4
By.
R BAIR CONDITIONED, INC.
650 W. Park Dr.#203
Miami, Fl.33172
CAC-057175
(305)216-7766
E-mail: rbendana5l@gmail.com
We, RB Air Conditioned,Inc.,soliciting to the Miami Shores Village Building Department to cancel the
city mechanical permit#MC-7-14-1566 for the customer,Tere&Sandri Medina,at: 117 NE 91 Street,
Miami Shores,F1.33138.
The reason to cancel said permit is because the customer say they do not have fund to do the job.
We are asking to the city to refund to us the permit fee that we already pay to the city of Miami Shores.
Do not hesitate to write or call us if you need further information about this matter.
Thank you for the attention given to our solicitude.
Yours,
Rica r a na
A/C,JNC.
RICARDOJJ.MAKEN E
Notary Pu6IiC-State of lorioa
Comm.Expires Jan 2 2016 `
%rc OF.f Commission# EE 1565f0
II,11110