RC-14-1339 Miami Shores Village RECEP"7Q
Building Department OCT 14 ` b
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
gl S PEST
ON LINE PHONE NUMBER:(305)762-4949
FBC 2014
BUILDING Master Permit No. RC-6-14-1338
PERMIT APPLICATION Sub Permit No. Rc-6-14-1339
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
VMA
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF F CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 398 NE 100 Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11032096091305410 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):Marjorie Warren Phone#:305 758-2923
Address:398 NE 100 Street
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Universal Plumbing Phone#:
Address:
City —State: Zip-
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: This contractor applied for these permits, but did not do the work.
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revisedo2/24/2014)
Y
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 °� Signature
el OW4'R or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
t n day of l/' 0�-d [De—V— ,20 1 (k, by day of 20 by
Dryer,who is personally known to who is personally known to
me or who has produced 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: Sign:
Print:��°_, /�6L - N5Zc)' Y--7 Print:
Seal: 2o,,a;N' CECILIALSWIFT Seal:
* * MY COMMISSION#FF 177025
EXPIRES:March 13,2019
,rfQ OF F��P��e Bonded Thru Suet Notary Sarvkes
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
p, Miami Shores Village �r1�� D
a
Building Department ; JUN 23 2014
�t 10050 N.E.2nd Avenue, Miami Shores,Florida 33138
IA �'��' ��� I� Tel:(305)795-2204 Fax:(305)756-8972
1X IN PECTION LINE PHONE NUMBER:(30S)762-4949
FBC 20 l
BUILDING a Master Permit No.RC 11-4— 1 �3CIS7—
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
F-14 11
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS [:] CHANGE ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS:.3 �j d'r/l/'+ 6�7_ /00 �[
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: aha o�'0�3�" �{�� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
j
OWNER:Name(Fee Simple Titleholder): r , Phone#: o r
Address: 2 0 O S7'
City: � ,.� State: Zip:
Tenant/Lessee Name: _ Phone#:
Email:
CONTRACTOR::Company Name: 6Ckf& WV W Phone#:
Address: 3&0
91 It-
City: in State: �� Zip:
3�3�1Z
H"
-7
Qualifier Name: Aj� //11 �(( //��r Phone#: e/
h k
State Certification or Registration#: [�l, �SA `1,�vL� Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ z isato Square/Linear Footage of Work:
Type of Work: ❑Addition ❑(�Alteration ('(❑',�NNew 1:jRepair/Replace _ Demolition
Description of Work: Irl V� r)VS1 ` 'Pw 11 LkI oK
Specify color of color thru tile:
Submittal Fee$so'o-� Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
Bonding 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 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 t e job site for the
first inspection which occurs seven(7)days after the building permit is issued. In the absence of such posted notice, t e inspection will not
be approved and a reinspection fee will be charged.
SignatureL�J� Signature
IV Owner or Agent ontra or
The foregoin trument was acknowledged before me this The foregoinginstrumentwa ackno ledged before me this
day of 20 by day of °W L/ ,20 A by
who is personally kno to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. i ion aU0ldfi®0111 fiD17,2017
NOTARYPUB rPG .. NOTARY PU C• MY COMMISSION►? o LOURDES MARIN g�+ EXPIRES April MY COMMISSION#FF009167 (dol)39&0153FlorideRlotaN9a
,�oP.. EXPIRES April 17,2017
ign: 91 ig
DD
rint:lD[l!/Gre Print: /_n ✓v G.�� '° �/��!/<(/f
My Commission Expires: My Commission Expires: /101
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Marjorie Warren
398 N.E. 100 Street
Miami, FL 33138
(305) 758-2923
September 24, 2016
By z41�`
Miami Shores Village
Building Dept.
10050 N.E. 2nd Avenue
Miami Shores, FL 33138
Re: Permit nos. RC-6-14-1338, RC-6-14-1339
Dear Sir or Madam:
A contractor applied for the above permits for work to be done at my house. To my
knowledge, these permits were never issued. The contractor was discharged and never
performed any of the work.
I wish to withdraw these applications and request that you close these permits.
Thank you.
Very truly yours,
r. 9,
l
Marjorie M. Warren