PLC-17-464 N, PI C4s4
Miami Shores Village " JT TOW Flumb1I1g
10050 N.E.2nd Avenue NE �� �
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,•, """' Miami Shores,FL 3313>�0000
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fi a� Phone: (305)795-2204 ��Y
twit tate 1X21 .<,, Expiration: 08/26/2017
Project Address Parcel Number Applicant
9723 NE 2 Avenue 1132060134210
GATOR 9723 NE 2ND AVE LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
GATOR 9723 NE 2ND AVE LLC 1595 NE 163 Street (305)949-9049
NORTH MIAMI BEACH FL 33162-
1595 NE 163 Street
NORTH MIAMI BEACH FL 33162-
Contractor(s) Phone Cell Phone Valuation: $ 5,000.00
Y&M PLUMBING INC (305)267-1676
_.._..__.. .....: _. Total Sq Feet: 0
Type of Work:NEW ADA BATHROOM WATER FOUNTAIN AND Available Inspections:
Type of Piping: Inspection Type:
Additional Info:NEW ADA BATHROOM WATER FOUNTAIN AND Top Out
Classification:Commercial Re Pipe
Scanning:1 Main Drain
Heater
Water Service
Final
Water Main
Lavatory
Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00
Invoice# PLC-2-17-63037
DBPR Fee $3.38 02/22/2017 Credit Card $50.00 $192.76
DCA Fee $3.38
Education Surcharge $1.00 02/27/2017 Credit Card $ 192.76 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $4.00
Total: $242.76
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
76c1rh�Futffe-
,Fr6ore,I authorize the above-named contractor to do the work stated.
February 27, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 27, 2017 1
Miami Shores Village
�. Building Department
2 �( 10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 -
INSPECTION LINE PHONE NUMBER:(305)762-4949J�"f
FBC 201q
BUILDING Master Permit Nox:'—C-!-6 -I G -273
PERMIT APPLICATION sub Permit NO.1 1 I a-(j(o Q
❑BUILDING ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
/� CONTRACTOR DRAWINGS
JOB ADDRESS: % 7� 3 DC c S ea c '? 7;- 7
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 'ZZ- 3,20& -01 -3 qA/Q Is the Building Historically Designated:Yes NO
Occupancy Type:C®Pw+c cy Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): 6,-4�b f_ X17.2 3 A�E,A l L a 4-L C_ Phone#: JO&
Address: 6--n-A.)L ,/( 3 5 f7
1)
City: b r-K Sly rt.s State: EL Zip: 3 3/f> 2-
Tenant/Lessee
Tenant/Lessee Name: Phone#:
Email: Iqn I --� 1
CONTRACTOR:Company Name: 1 �04 Plym� iM. -N C Phone#:
Address: �W®l S.G/. /29 C74—
It
City: Tl�11�+2��(// / / State: FL Zip:
Qualifier Name: TA M4 `-A / Phone#:
State Certification or Registration#-:I � �7 0' Certificate of Competency#:
DESIGNER:Architect/Engineer: ����� r•�t 9�+l du Phone#:
Address: l 1'1/ Wes f ��w ��� City:P141-4111d L-% State:/"( Zip:
Value of Work for this Permit:$ �!oo�•�® Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Pe w
s
h p
Specify color of color thru tile:
Submittal Fee$ 50 PSD' Permit Fee$ -�P CCF$ CO/CC$
Scanning Fee$ /1 Radon Fee$ S DBPR$ 3' 3 Notary$
Technology Fee Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ ++
TOTAL FEE NOW DUE$ I _
(RevisedO2/24/2014)
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 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 hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not b ap roved and a reinspection fee will be charged.
o ,f
Signature Signature
S OWNER or AGENT CONTRACTOR
The foregoing instr ent was acknowledged before me this The foregoing instrument was acknowledged before me this
2( day of 20 by !21 day of e�J_ 20 l- by
o is personalty know YCevJ WtAym1O wh is personally known t
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:
ike Vazquez
Sign: 0 FP"28O Sign:
Print: R` Print: c0
Seal: Seal: www AARONNOTMr.CMI
APPROVED BY i�" -��� l Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)