PL-13-1350 CE
FR90
Miami Shores Village ,IUN 12 2013
\� Building Department
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(�v" 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
1' Tel:(305)795.2204 Fax:(305)756.8972, ,
INSPECTION'S PHONE NUMBER: 30 762.4949
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FBC 20
BUILDING Permit No. 'el- 13
PERMIT APPLICATION Master Permit No.
Permit Type: PLUMBING
JOB ADDRESS: �S3 q 4 SCl
City: Miami Shores County: Miami Dade Zip: 3 g
Folio/Parcel#: I — 3Z (o e 08 (Ol l O
9
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): ^IG P"'9l0eto Phone#: _W�(P 3r-(3 07101
Address;_ �3 Q-F— a 4 '�=r
City: State: i_ Zip: 33 3�?
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: (1 �� � Phone#: -3
Address [ ��J ►� LUQa�D
City: State• Zip: 33t9
Qualifier Name: W t 11iPYA Phone#: o 21-310 1S1:S_Ct r1
State Certification or Registration#: t' `+: t Certificate of Competency#:
Contact Phone#: CS `D(AP-S� Email Address:
DESIGNER:Architect/Engineer: 01 14 Phone#:
Value of Work for this Permit:$ 12A�fsD Square/Linear Footage of Work: LSA
Type of Work: OAddress OAlteration ❑New 'XRepair/Replace ODemolition
Description of Work:_ 1A«_ 170-�
r// h_\Cn_
Submittal Fee O Permit Fee$ �" CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ ALL,-
,.Bonding Company's Name(if applicable) fJ
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
0.'
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
-1 F1,NANCING, 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 a ve a inspection fee will be charged.
Signature Signa,
Owner or Agent '4'' Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 t3by AJC��r-cL,-V day of J-T�-2013,by WWpaAD44
who is personally known to me or who has produced 4 — who irsonally knov o me or who has produced
_ J�WSPrAs identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
SiNOTARY P I - Sign: VQTADY PUBLIC STATE
Print: _ Jazzmin Cruz Jazzmin Cruz DA
Print: _
Expires: SEP.28,2014 014
My Commission Expires: My Commission Expires: �'••, .••` Expires: SEP.28,2014
BONDED TFiRC All d�TIC B0..NDDiG CA,1NC, B01'DED 7kRG AAA,,,nC B0\-DDjG CO.,INC,
APPROVED BY �— 1.3 Plans Examiner Zoning
Structural Review Clerk
E (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)