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RC-12-924 I Miami Shores Village E , D a: 9 , Building Department MY �" 2 s 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 BY: ------aooeeee°o- INSPECTION'S PHONE NUMBER: (3057 762.4949 FBC 20 B ILI 11N Permit No. , PERMIT APPLICATION Master Permit No. IL Permit Type: BUILDING ROOFING JOB ADDRESS: &eE '73 9 City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): JQYA Phone#: ql zl W7—�E- 7 Address: 12 15- 12i_- 17 �P City: hAMI Y ,,ec State: Zip: 3 C Tenant/Lessee Name: Phone#: Email: q CONTRACTOR: Company Name: Phone#: Address: City: State: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: tpj�oc i_ Phone#: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: Addition DAlteration ONew 9 ORepair/Replace ❑Demolition Description of Work: ` ILXD e Ll Color thru tile: *Feex •� o Submittal Fee$ Permit Fee$ / CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ 5 ' 0111-a °f)d) TOTAL FEE NOW DUE$ Bonding Company's Name(if applicable) > °' Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) C ITI W Mortgage Lender's Address �6—2 Y3-7711 1 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 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 not be approv d and a reinspection fee will be charged. Signature Signature O er r Agent Contractor The foregoing instrument was acknowledged before me this J1 S+ The foregoing instrument was acknowledged before me this day of ,20 L,by"qui i \A%. I'Y�C+Li S2 , day of ,20_,by who is personally known to me or who has produced FAWi C who is personally known to me or who has produced �(o5sz �s identification and who 4Ktake an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign:��Qk k; e4 LL Sign: Print: Print: MIM M-1 My Commission Expires: ?,# 4 Notary Public-State ]2013 My Commission Expires: My Comry Expires May,Commission#DD 8 9 RP APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 5/2/2012)(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) December 7,2015 Miami Shces Building Department Miami Shores, FL 33138 D 4 7 2015 Dear Miami Shores Inspector, I submitted the plans to do an addition on my property located at 1255 N. E.93rd Street. Permits were opened. I decided not to complete the addition and am kindly requesting that the permits be canceled. Best regards, Jeffrey Mayer ( 9 2 F-L 12-C>12-, to n , Notary Public State of Florida `,; Sindia Alvarez '�y < My Commission FF 158750 �ofp'o Expires 09/03/2018 V �Y- t'�