PL-17-3007 ��mi��o�oxm�ov
' 1oosVw.s.2nd Avenue ms t Wofk C/assification..Addition/Alteration
Miami Shores,FILon1n8-0000 Per, I Petmit Status. APPROVED
Phone: (305)795-2204
"ue Date: 1110/2018 Expiration: 07/09/2018
Project ` Parcel Number Applicant
9225 NE 12 Avenue 1132050270390 LOURDES B I A�ASANZEW
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
LOURDES B KASANZEW 9225 NE 12 Avenue (786)355-1124
MIAMI SHORES FL 33138-2928 /
9325 NE12Avenue
'
MIAMI SHORES FL33130_2328
Contractor(s) Phone Cell Phone Valuation: $ 700.00
NORTHWEST PLUMBING INC (786)586-5203 (305)986-1157
— Total Sq Feet: 30
Type of Work:RENOVATION OF GUEST SERVICE BATHROO m |
Type of Piping: Inspection Type:
Additi'onal Info:RENOVATION OF GUEST SERVICE BATHROO Top Out
Bond Return: Final
Classification: Residential Scanning: 1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Arint Due
CCF $0.60 Invoice# PL-12-17-65991
DCA Fee $3.00
Education Surcharge $0.20 01/10/2018 Check#:210 $262.10 $0.00
Permit Fee $300.00
Scanning Fee $3.00
Technology Fee $0.80
'
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I c ify that all th f ing-1 formation is accurate and that all work will be done in compliance with all apolicable laws
regulating
I
Miami Shores Village R �
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Building Department DEC 27 7017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 4-1
\ Tel: 305 795-2204 Fax: 305 756-8972
% INSPECTION LINE PHONE NUMBER:(305)762-4949 1 1
FnBC 201q
BUILDING Master Permit No. !z C r9 - 182
PERMIT APPLICATION Sub Permit No. PI I-9 _-2C 07-4
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP
, I CONTRACTOR DRAWINGS
JOB ADDRESS: - / I JF, GyL
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
�
OWNER: Name(Fee Simple Titleholder): AN 16A!E� )W Q?7E—::7k'Phone#:
Address: qa—( � �� IY �� _
City: i (,( M-A CS l if State: Zip: �3 I
Tenant/Lessee Name: Phone#:
Email: -�
CONTRACTOR:Company Name: v Phone#(3( 7 y
Address: v
City: State: �� zip-3 3 I Dc
Cdualifier Name: / ' Phone#: �L�p ' V/_�C/�3
State Certification or Registration M j- �"T -4 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
I
Address: City: State: �^ Zip:
Value of Work for this Permit:$ `7(O. 00 Square/Linear Footage of Work: 30 lJ(T1,wif
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: b2;1 VU-('7'ry-)
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ YO CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ !�� • V
(Revised02/24/2014) `
Bonding Company's Name(if applicable)
Bonding Company's Address _
City State Zip
i
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 app ved and a reinspection fee will be charged.
Signature Signature<Sj 0 Vim"'"o
r
R or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Sfi day of N(7�Q.f/ 1lLC�.)SIX 20 ) 1 by C9 day of 1�)C�`v 20 i by
E �� 0-7_C`` w,who its personally known to IC!Uou-clo' ( who is personally known�0
me or who has produced U C`U 31& as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARYP LIC: NOTARY PUBLIC:{
r
V
Sign: Sign.
Print: Print: A `— �� • V�
Seal: °' NWY PUNC Stele M Florida Seal:
Addena Garda • a�Flalde
My Commission GG osAdrknaftda
Explms 0006=21 My Com Mubn GG 091024
APPROVED BY //' — Plans Examiner Zoning
Structural Review Clerk
(Relvised02/24/2014)
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