RC-15-1446 Miami Shores Village
Building Department JUN, 122015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20)i�7
BUILDING Master Permit No.,Cz5___ Z!211/1<
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PERMIT APPLICATION Sub Permit No.
�UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
j� lot CONTRACTOR DRAWINGS
JOB ADDRESS: ," �J 1®t
City: Miami Shores County: Miami Dade Zip: l
Folio/Parcel#: Is the Building Historically Designated:Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ou s I�i PAn Pt_/b Phone#: 3 aS-clUa
Address: ?i ®�� I SI-
City: i_4 L7�tto ( � i �'1�''S State: Zip: 3(3
Tenant/Lessee Name: Phone#:
Email:
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CONTRACTOR:Company Name: ` Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER. rchite /Engineer: (5 �� Phone#: `2i c rl
Address• S AJ r 2-Se City: M 54Z,"tate: "` Zip: i
Value of Work for this Permit:$ ( 0 0 00 w� Square/Unear Footage of Work: Zo %_) _
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: o mil ^1L- f��xt,S n td- LA,~ "
4,
Specify color of color thru tile: °
Submittal Fee$G^^ ®t�9''OPermit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ �'�_Notary$ 0jfy
Technology Fee$ AZ 4D Training/Education Fee$ 3s ZNO Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ � �
(Revised02/24/2014)
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 qngLconstruction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified Wrded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) 1 permit is issued. In N nce of such posted notice, the
inspection will not be approvedhand a reinspect a charged.
1
Signature Signature
ONE or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_ day of 20 ,by day of 20 ,by
�� who is personally known to who is personally known to
me or who has produced m2f2 = as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: n
rPrint:
Noury Public Stme dwbrwa
JoanSeal: My
Feliciano Seal:
My Camiasicn FF 082753
n Expires 01/12/2018
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APPROVED BY A Plans Examiner �Jf t'Z l )-- Zoning
Structural Review Clerk
(Revised02/24/2014)
Ja~
LAURA MARIA RODRIGUEZ
78 NE 101 Street
Miami Shores, FL 33138
February 16, 2016
Mr. Ismael Naranjo, Building Official
Building Department
Miami Shores Village Hall
10050 NE 2 Ave
Miami Shores, FL 33138
Dear Mr. Naranjo:
By means of this letter, please be informed that I would like to cancel the permit
to create a bathroom and bedroom out of an existing utility room. The permit
number is RC15-1446.
We are not going to make any changes to this home.
Thank you for your attention to this matter.
Sincerel ,
u M Rodri uez