PL-18-441 Permit NO. PL-2-X18-44 1
Asx°R hs Miami Shores Village Permit Type:Plumbing-Residential
s� 10050 N.E.2nd ANE
venue Per. � � Worts Classification:Gas
Miami Shores,FL 33138-0000Permit Status:APPROVED
Phone: (305)795-2204
F�ORLDA
issue Date.317/2018 Expiration: 09/03/2018
Project Address Parcel Number Applicant
1255 NE 99 Street 1132050090100 JOSH WOLLOWICK
Miami Shores, FL 33138-2642 Block: Lot:
owner Information Address 1Phone Cell
JOSH WOLLOWICK 1255 NE 99 Street (305)531-0970
FL 33142-
1255 NE 99 Street
FL 33142-
Contractor(s) Phone Cell Phone Valuation: $ 5,000.00
DEL RIO&SON PLUMBING CORP (786)295-0098 Total Sq Feet: 0
Type of Work:GAS AS PER PLAN' a Available Inspections:
Type of Piping:GAS AS PER PLAN j) )/ j ; v /� i
/ j � � Inspection Type:
Additional Info: L
Final ,.
Bond Return: Press Test
Classification:Residential Scanning: 1 Review Plumbing
r
Fees Due ' 'Amount Pay'Dat6` Pay Type. Amt Paid Amt Due
CCF t $3.00
Invoice# PL-2-18-66515
DBPR Fee $3.38
DCA Fee $2.25 02/21/2018 Credit Card $50.00 $ 191.63
Education Surcharge $1.00 03/07/2018 Check#: 181 $ 191.63 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $4.00
Total: $241.63
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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 AFFIDAVI 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 zo m uthermore;I authorize the above-named-contractor to do the work stated.
March 07, 2018'
Authorized gnature:Owner / Applicant / Contractor / Agent Date
Building Iiiepartment Copy
March 07, 2018 1
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Miami Shores Village
Building. Department BY: -
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 �h
BUILDING Master Permit No.,F—C-( - �SZ
PERMIT APPLICATION Sub Permit No.m, ( l
'BUILDING r-1ELECTRIC [--1 ROOFING REVISION EXTENSION RENEWAL
,wPLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF F-1 CANCELLATION E] SHOP
��� CONTRACTOR DRAWINGS
JOB ADDRESS- 12 SS N c q 9 ST
+City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building.Historically.Designated:Yes NO .�
Occupancy Type: Load: Construction Type: II Flood Zone: BFE: FFE:
#OWNER:Name(Fee Simple Titleholder): 54 Wy Aa uJ1G� Phone#:.
Address: �L-r•� Ne 3l
City: Stater" Zip:
Tenant/Lessee Name: Phone#:
Email: Q
CONTRACTOR':Company Name: C'� �.�J Phone#::C fL'7��2CQ 5 U o 9 j
Address: �qo
Q (;\)3
City: State: Zip: (C15_
Qualifier Name: Phone#: -7 2
State Certification or Registration#: Q PC. IA21 (t�2 ertificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:.
Address: City: State: Zip:
Value of Work for this Permit:$ 5���" ° Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 614J 111' Al— IJ
Specify color of color thru tile:
Submittal Fee$� CO __Permit Fee$ �� CCF$ CO/CC$
'Scanning Fee$ 3 Radon Fee$ Z • ZS DBPR$ 3 .3 6 Notary$
'Technology Fee$ 4 Training/Education Fee$ Double Fee$
Structural Reviews$ Bond'$ Q L?
+ TOTAL FEE NOW DUE$
(Revised02/24/2014)
f
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 deliver
osted the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must t the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absen f uc po ed notice, the
inspection will not be approved and a reinspection fee will be charged. /
Signature Signature
OW or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instr t was acknowledged before me this
2.a day of �� `"'°j"Y .20 Jt ,by day of �--'-d .20 ,by
who is personally known to o is personally known to
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 P LIC:
Sign: Sign:
Print: AA)A H9rl,9 /,g �i<? ,._ M..+.. Print ANA F CONIL
{{ Mai u vu.....
,� =iP� Notary Public-State Of Florida
Seal: ��a ��; aQ°J t:M29133 Seal: .•
Commissbn r GG 067653 �
r" EXPIRES: June 4, 2016 `a Ay Comm.Expires Jan 30,2021
••;FOf Bpdeditw hNaGp+ WiryA—
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APPROVED BY 9XV —ZZ(� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)