RC-14-1933BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
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 20
Master Permit No. �Gl —
Sub Permit No.
r,t
DEC 2.3 2016
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❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
— CONTRACTOR DRAWINGS
JOB ADDRESS: 1 l (00 U£ q Q S T Q
City: Miami Shores l� p, County: Miami Dade Zip: 313 Si
Folio/Parcel#: 1 )- 3 a b - �/ 1 Z) 0�� 0 I the`BuildingBHistorically Designated: Yes
i NO
Occupancy Type: L— Load: . . Construction Type: V Flood Zone: \A BFE: 11. 6/bFFE:
OWNER: Name (Fee Simple Titleholder) Lqr(2i P✓ +�1 (LkD Phone#: 305 -Lot. i Oct 1
Address: I' Ip 0 05:0-- q cb •`c✓ T
City: 1v, P\1. tet A 0 e.. S State: "V Zip: j 1 D46
Tenant/Lessee Name:
Email: YN/\ra-Jo @ 6 vin .f . a
Phone#:
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Neetei• GP Phone#:
State Certification or Registration Certificate o petencys#:
DESIGNER:Archiittect/Engineer: f ctoe,rt J u -G•. r a _ P \ P D-� Phone#: '194-14,4 4 - l 3
Cb
Address: b "1 5 0 5L.
,) Z-01 S -1 City:C X 1 1 f)k yState: C-L'Zip: 3✓ 1
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition I I Alteration ❑ New
❑ Repair/Replace ❑ Demolition
Description of Work:
.14
Specify color of color thru tile: 1,111.0 ° s
Submittal Fee $ Permit Fee $ CCF $ ' : <<. CO/CC $‘ '1 Y
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ 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 PRO EIfY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR A lip.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
R or AGENT , CONTRACTOR
The foregoing instrumen was acknowledged re me tthisCt The foregoing instrument was acknowledged before me this
I 1 ' day of1\Q,,LIAih./lKI0 I.
LO , by day of , 20 , by
toP-• V PD ,I4 klzb 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: Alk , ' SW�',� Sign:
Print: ( , n I "'e1 IP T Print:
DANIELLE BARBARO
Seal: .`NOT�F C Seal:
t 1= STATE OF FLORIDA
" °IL ''� Comm& FF101001
•
APPROVED BY
(Revised02/24/2014)
Plans Examiner Zoning
Structural Review Clerk
MARYBELL RAJO
1160 NE 98 STREET
MIAMI SHORES, FL 33138
305-609-0091
DECEMBER 15, 2016
MIAMI SHORES VILLAGE BUILDING DEPARTMENT
10050 N.E. 2ND AVENUE
MIAMI SHORES, FL 33138
RE: RC 14-1933
TO WHOM IT MAY CONCERN:
I AM THE OWNER OF THE PROPERTY LOCATED AT 1160 NE 98 STREET, MIAMI
SHORES, FL 33138.
PLEASE BE ADVISED THAT A BUILDING PERMIT WAS NEVER ISSUED BY MIAMI
SHORES VILLAGE AND NO CONSTRUCTION WAS EVER INITIATED IN
REFERENCE TO ABOVE -CAPTIONED PROCESS NUMBER AND/OR PROPERTY.
PLEASE CANCEL THIS BUILDING PERMIT APPLICATION EFFECTIVE
IMMEDIATELY.
PLEASE ALSO ACCEPT THIS LETTER AS MY REQUEST FOR A REFUND OF ANY
PERMIT FEES, IF APPLICABLE.
SINCERELY YOURS,
�The forego" g instru ent was acknowledged before me this day of
.� , 2016 by MARYBELL RAJO, who is personally
known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
SIGN: (DID
PRINT: eI c -
SEAL:
DANIELLE BARBARO
of NOTARY PUBLIC
STATE of FLORIDA`:• :;,•.�+FF101601
E Ccs Expires3/23/2018