Permit Application — Helena Rubio, Permit 2005103673 (2005)

MIAMI-DADE COUNTY BUILDING DEPARTMENT Permitting and Inspections Division 11805 SW 120th St., Miami, FL 33177-2674 * (786) 315-2100 PERMIT APPLICATION PROCESS # 20201203673 LOCATION OF IMPROVEMENTS Lot Address: 16211 S. Dixie File: 12010 12434 036730 Block: Plat: Water and bounds: TYPE OF IMPROVEMENTS [ ] New Construction on existing structure [ ] Addition to existing structure [ ] Alteration Interior [ ] Alteration Exterior [ ] Addition to Structure [ ] Addition Detached [ ] New Roof [x] Repair (Roof) [ ] Demolish [ ] Repair to Fire [ ] Repair to Structure [ ] Site Only [ ] Foundation [ ] Other (Describe): CONTRACTOR INFORMATION Contractor No.: C-22-3181 Contractor's Name: SEVER CONSTRUCTION CORP. Address: 16211 S. Dixie Hwy. City: Miami, FL Zip: 33157 OWNER'S NAME Owner: Melissa Rubio Address: 16211 S. Dixie Hwy. City: Miami, FL Zip: 33157 Special Security: DESCRIPTION OF WORK Description of Work: Roof Repair This is a 1 story structure. Roof Year Built: 1960-70 BUILDER'S NAME Builder's Name: SEVER CONSTRUCTION CORP. Address: 16211 S. Dixie Hwy. City: Miami, FL Zip: 33157 ENGINEER Name: Address: City: State: Zip: ARCHITECT Name: Address: City: State: Zip: MORTGAGEE Name: Address: City: State: Zip: BONDING Amount: Surety: Bond No.: CHANGE TO AN EXISTING PERMIT [ ] Building [ ] Electrical [ ] Mechanical [ ] Plumbing [ ] Gas City Contractor No Issued Expired Rescinded CITY OF WEST MIAMI Signature: Sandra Date: 2/6/20 Name: Title: I certify that I am the owner of the property described above or that I am duly authorized to act on behalf of the owner, and that the information given is correct. I understand that this permit is not valid until signed by the Building Official and that the permit expires 6 months from the date of issuance unless construction has been authorized. I understand that I must obtain a Certificate of Occupancy before occupying this building or structure. I understand that I am responsible for compliance with all applicable laws and regulations. Owner's Name: Melissa Rubio Owner's Signature: [Signature] Date: 2/6/20 By: [Signature] Title: Owner Contractor's Name: SEVER CONSTRUCTION CORP. Contractor's Signature: [Signature] Date: 2/6/20 By: [Signature] Title: President Architect's Name: Architect's Signature: Date: Engineer's Name: Engineer's Signature: Date: City of West Miami Building Official: [Stamp] Date: 2/6/20 Permit Fee: $25.00 Total: $25.00 Paid By: Check Check No.: Received By: [Signature] Date: 2/6/20 2