PL-18-1906Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Per
it
Permit NO. PL-7- 8-1906
Permit Type: Plumbing - Residential
Work Classification.' ° Addition/Alteration
Permit Status: APPROVED
Date: 7/19/2018 Expiration: 01/15/2019
Parcel Number
Applicant
195 NW 91 Street
Miami Shores, FL 33138-
1131010000190
Block: Lot:
DANELLE BANCROFT
Owner Information
Address
195 NW 91 Street
MIAMI SHORES FL 33150-
Contractor(s)
LASSETER PLUMBING CO INC
Phone Cell Phone
(305)525-5075 (305)893-7180
Phone
Cell
Valuation:
Total Sq Feet:
$ 7,000.00
0
Type of Work: 2 BATHROOM REMODELS KITCHEN REMODEL
Type of Piping:
Additional Info: 2 BATHROOM REMODELS KITCHEN REMODEL
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$4.20
$3.68
$2.45
$1.40
$5.00
$245.00
$9.00
$5.60
$276.33
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-7-18-68236
07/19/2018 Credit Card $ 226.33 $ 50.00
07/16/2018 Credit Card $ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Final
Review Plumbing
Underground
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 certi t t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zgpjng. FutheIm re, I authorize the above -named contractor to do the work stated.
Authorized ature: Owner / Applicant / Contractor / Agent
July 19, 2018
Date
Building Department Copy
July 19, 2018
1
BUILDING
PERMIT APPLICATION
BUILDING ELECTRIC
14 PLUMBING ❑ MECHANICAL
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ROOFING
PUBLIC WORKS
JOB ADDRESS: I615 N V V'i t S QL+
City: Miami Shores
Folio/Parcel#: ' '5101 ' 0 00 - o 10i o
Occupancy Type: rieS Load:
County:
RECEIVE,
JUL 162018
FBC 20R
Master Permit No./RC 1?)^ \-148
Sub Permit No.? 1 `B ‘"'Q j
❑ REVISION ❑ EXTENSION 0 RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade Zip:
33I5a
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Da r}e) le.P2,51
Address: VA I MI5 N W c1 I Y-ee-i---
Phone#: 30S' 491.1 %31
City: VY11 aYY11 SV Dr25 State: zip: 3315-o
Tenant/Lessee Name: _ Phone#:
Email:
CONTRACTOR: Company Name:
Lot ss e{e- P I U m b i vig
Address: g6)6 NCE
City: N Dr+k rY)1 oYn 1 State: -FL-
Qualifier Name:
State Certification or Registration #: Zs•re. 04 16CF
DESIGNER: Architect/Engineer:
Address:
Certificate of Competency #.
Phone#: 3O5 g93 12 b
Zip: ) 69
Phone#: SO-5 — S`{3 - /80
•
Phone#:
Value of Work for this Permit: $
17190 "
Square/Linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration
City: State: Zip:
❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: rx+ 12 7Y� re-P�VY(�¢ IJ S , I -i ±&ua 1 rery) bDs
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $ , U 5- QL
Radon Fee $ 2. --1 5
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $ 3' 9 Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ - 2
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 which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me thissl
v 21 day of rvoe. , 20 ig , by 1Z_ +" day of
personally Erie BCW1G'DdT ,who is ersonall known to jinn • • LQSS-e r , who is personally known to
me or who has produced as e or who has produced .riV•QY `1 Cktrls' as
n'e
,20 '8 ,by
identification and who did take an oath.
NOTARY PUBLIC:
identificatio
NOTA
Sign: —/�f� ,�,rj(f ' Sign:
Print: t4.,CjYieP1 1 • -ifu Print:
Seal: A 1./! 0,'% Marien I. Rios Seal:
iI� os
COMMISSION #FF924405
EXPIRES: October 5, 2019
• WWW.AARONNOTARY.COM �_
APPROVED BY //1. Plans Examiner
ath.
17
YANADY PRIETO
MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
cd.;4° Bonded ThruRotaryPuhicUnderwriters
voutatzvogssm
Zoning
(Revised02/24/2014)
Structural Review Clerk