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PL-18-611,SNURE9 D�lp��,�, Miami Shores Village 10050 N.E. 2nd Avenue NE " Miami Shores, FL 33138-0000 Phone: (305)795 2204 FCORiDp' Permit NO. PL-3-18-611 Permit Type: Plumbing - Residential tWofk Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 3/9/2018 1 Expiration: 09/05/2018 Project Address Parcel Number Applicant 1321 NE 103 Street 1132050300120 Miami Shores, FL Block: Lot: ADRIA I SILVERMAN Owner Information Address Phone Cell ADRIA I SILVERMAN 1321 NE 103 Street (305)542-0908 MAMI SHORES FL 33138- 1321 NE 103 Street MAMI SHORES FL 33138- Contractor(s) Phone Cell Phone LONCUS PLUMBING CONTRACTORS (305)218-1004 Type of Work: PLUMBING FIXTURES FOR SHOWER FIXTUR Type of Piping: Additional Info: PLUMBING FIXTURES FOR SHOWER FIXTUR Bond Return Classification: Residential Scanning: 3 Fees Due Amount CCF $3.00 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $1.00 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $170.25 Valuation: $ 4,100.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-3-18-66730 03/08/2018 Credit Card $ 50.00 $ 120.25 03/09/2018 Credit Card $ 120.25 $ 0.00 /Avauauie Inspection Type: Top Out Plumbing 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 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction end zoning. Futhermoje, I a thorize the above -named contractor to do the work stated.11 March 09, 2018 Authorized Signature: Owner / pplicant / Contractor / Agent Building Department Copy March 09, 2018 1 �q�IQ- �� ��le�/�1nC-vl 3C�5_ S`�a-p300 P1 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 RECEI`dEL MAR 0 8 2018 FBC 201=4 BUILDING Master Permit No. �C- I — PERMIT APPLICATION Sub Permit No. ` (18 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 5/PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 13 Q-- I N e 103 1-j STf City: Miami Shores County: Miami Dade zip: 3 3 1.39 Folio/Parcel#: ( ( 3 9-05-D 3 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): V-C6 1 (I�eTc�rw'tzi -_ J "� —0 30 0 Address: D22 JYP_ City: 1ssNr mi 5-hn oPS j� State: �L zip: 33 13g Tenant/Lessee Name: t N 1 f _ i Phone#: Email: t�y- CcLs (t�"e rm -, Q qM CONTRACTOR:Com any Name:r/1) 1i1.�� ��"/�� Phone#: f' p 1 Address: ►�/1 `_ W Hip City: LhAlai Qualifier Name: G State Certification or Registration #:/i-1a� Certificate of Competency #: / p DESIGNER: Architect/Engineer:/ �nLc4 � r�caJ� Le Phone#: � Address:_rL� �/�% �� �? ft11 v6 City: ���J",- . a State: �_ zip: 3 33 (�j Value of Work for this Permit: $ 1 03 Square/Linear Fo age of Work: Type of Work: ❑ Addition ❑ Alteration New Repair/Replace ❑ Demolition Descriptio of Work: Or, Specify color of color thru tile: ) ° Submittal Fee �1 Permit Fee $ ! CCF $ 3 CO/CC $ Scanning Fee $ Radon Fee $ Z DBPR $ 2 . ZS Notary $ Technology Fee $ Training/Education Fee $ I Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ \ l t�D �J (Revised02/24/2014) i( Bonding Company's Name (if applicable) Bonding Company's Address City State 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. A Signature OWNER or AGENT Signatu The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 1 20 b�y, )02- day of F� /wA�y 20 by who �s\vl ow- n to r %r �P� 19;C / d who is personally known to me or who has produced ( i QD 5e las me or who has produced l /_ /C-' J,�.� L as identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: , Print: �P•••., MAHARAIK.G0trG044602 Print: /tl� ' M S: November 2, 2020 • A�V�Seal: = Notarypubtic Underwriters Seal. `:=edPThN Notary Public - Sta?e of Flo Commrssron Bond �? ••%�Oc Jd,\ GG0933•:S MyComm. Exa•2s Aor 11, F?p•' 60r92d t4 P14 —9 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)