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PL-13-1928 Miami Shores Village R-W(-,_ , Building Department AU' 13 �13 ,juv i0 N.E.2na Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 BY INSPECTION'S PHONE NUMBER:(305)762.4949 —— FBC 20 BUILDING Permit No."�U `3 4. 2-Y PERMIT APPLICATION Master Permit NaG�—� Permit Type: PLUMBING CANCELLEDJOB ADDRESS: N l% l City: Miami Shores r County: Miami Dade Zip: 173,1515 Folio/Parcel#: -( L - 7 1 S(-,, - co(-(2 — 0 Is the Building Historically Designated: Yes NO Flood Zone: r l OWNER:Name(Fee Simple TitIeholder): —7t` - -. sAF L L EDne#: -7euO �-Io-1 SI Address: S y(% 1©� City: Vv", c -2-� t _State: L Zip: �3 I Tenant/Lessee Name: Phone#: Email: ' �f t CONTRACTOR:Company Name: P _ C- Phone#:G b 1�f/ ?- /s�p J Address: w G- City: State:, (� _Zip: :Y,3 2. Qualifier Name: ( 1 O l a �j( GY e E'Y1 Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ Ov Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑ ew RRepair/Rep ace ❑Demolition Description of Work: l 11/1 C� *xx+a*w�M�a*����x��:xx**.,..,�.*aax**�**�•x��:Fees**x**�x:*x****:zx:�a:*�****�+a*x�a*�*a�x�:�x**�** Submittal Fee$ Permit Fee$ SSC` 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 NOT117E 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 a d and a reinspection fee will be charged. Signature Signature C . 1111p111111/1V / ��LASH /,11111111111 caner or Agent Contractors tfore estrum re me this t,!!2 The fore of g instrument was acknowledged before me this o: Al • Q •' 20 � ly � day of ,2(�,by E ' w• s p D _ro me o o has produced who is person lly known to me or who has produced !�L'• x �� dentification and who did take an oath. as identification and who did take an oath. �a z m y p NOTARY P a W F�118 C fJ Sign: Sign: Print: ��.�- Print: Sa My Commission Expires: �f�`� My Commission Expires: -7r�� r APPROVED BY � Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07)(Revised 06110/2009)(Revised 3/15/09)