PL-13-372Address: I. z- (, L o L
City: ( . 5 f,t.
Tenant/Lessee Name:
BUILDING
PERMIT APPLICATION
FBC 20 txp
Permit Type: PLUMBING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. PLr 3 --312
Master Permit No. RC 1 Z — Z-1 9 S
RE C -;xv D
FEB 2 5 2013
r3Y:
OWNER: Name (Fee Simple Titleholder): L 1 2, Cr Gt`a0 tf ; t{••eZ Phone#:'.act5_ Z ( Z-2-Z k
S�r cl
State: i' C 4/1/CettertZip: Phone#:
Email:
JOB ADDRESS: /, p.3 NE E ! 67 / s�`2
City: Miami Shores County: FL Miami Dade
zip: 33
Folio/Parcel#:
Is the Building Historically Designated: Yes NO X Flood Zone:
CONTRACTOR: Company Name:
A Lc.
Address: 2620 Si l) '2'2 541 �j/'{Q 2-
City: l�-•itlrLf'h/ State: f C,
,4 (/flip o r. rJ.)5-de
Qualifier Name:
'. 4
State Certification or Registration #: -e /it2 V Certificate of Competency #:
Contact Phone#: Email Address: ALL7`-e---ii,Lornd/N&e c9/1-1,44-• deA1
DESIGNER: Architect/Engineer: 5vy' rite Stv,; 1i, 5 i s2 V, �' o t Phone#:S. _ al 2.-- 9.4
Phon
305)345'06g
Zip: g3/
Phone#: ()3 3�
Value of Work for this Permit: $ b1 16- c2C G Square/Linear,Footage of Work:
Type of Work: DAddress liAlteration ❑New . ` " `❑Repair/Replace ❑Demolition
14Q. w K%.\- t vvt , 2 (-)
Description of Work:
Submittal Fee $ •Oa .CD Permit Fee $
Scanning Fee $ G Radon Fee $
Notary $
a3/
CCF $ CO/CC $
DBPR $ Bond $
Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 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
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU „_ INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER ti 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 coitunencement 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. z k,
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this:
day of 44-4W , 20 P, by C1.../41-40' J ✓LJ2 ij ,c•C
who is personally known to me or who has produced i4-4
As identification and w4Rtdiddtag/An oath.
100/..
n/s '%44.
Sign: Print: ��.%ce s/ q,,.'
AORIDP .�`���
Rk`��
NOTARY PUBLIC:
My Commission Expires:
Signatur
Contractor
The foregoing instrument was acknowledged/before me this a 5�
day of ../4/-i(4%7 ,20/�,.by671tz, 5-v fi/
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: 49/774/ �i%L tom'�j'2 ���� , limo
Comm# DD0915552
s . Expiies,8/10/2013
My Commission Expires: %/t/a0ye
XIOMARA PINARES
NOTARY PUBLIC
STATE nF FLORIDA
****************************,,•-******************************************+***********************************
APPROVED BY
Plans Examiner
Structural Review
J►
Zoning
Clerk
ti4
(Revised 07/10/07)(Revised 06/I0/2009)(Revised 3/15/09)